Provider Demographics
NPI:1699177006
Name:AMANDA M. MATZ, DPM, A PODIATRY CORPORATION
Entity type:Organization
Organization Name:AMANDA M. MATZ, DPM, A PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:530-885-7047
Mailing Address - Street 1:11879 KEMPER RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9021
Mailing Address - Country:US
Mailing Address - Phone:530-885-7047
Mailing Address - Fax:530-885-4614
Practice Address - Street 1:11879 KEMPER RD
Practice Address - Street 2:SUITE 8
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9021
Practice Address - Country:US
Practice Address - Phone:530-885-7047
Practice Address - Fax:530-885-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4650261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric