Provider Demographics
NPI:1992754113
Name:CUSICK, WILLIAM MATTHIAS (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MATTHIAS
Last Name:CUSICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:344 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-3631
Mailing Address - Country:US
Mailing Address - Phone:559-664-4207
Mailing Address - Fax:559-675-5224
Practice Address - Street 1:1690 UNIVERSE CIR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-2441
Practice Address - Country:US
Practice Address - Phone:805-204-9135
Practice Address - Fax:805-204-5286
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX70590Medicaid
CA00AX70590Medicaid
CAW20A70591Medicare PIN