Active NPI
Matthew Angkadjaja
- Nurse Practitioner
- Loma Linda, CA
National Provider Identifier
1073462610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95034134
- Practice address
- 11467 Via Lagos
Loma Linda, CA 92354-3851 - Phone
- (626) 231-9465
- NPI assigned
- Jan 27, 2026
- Last updated
- Jan 27, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95034134 | CA | Primary |
Addresses
Primary practice location
11467 Via Lagos
Loma Linda, CA 92354-3851
Mailing address
11467 Via Lagos
Loma Linda, CA 92354-3851
Phone (626) 231-9465
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95034134 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1769472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769472000000",
"number": "1073462610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11467 VIA LAGOS",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543851",
"telephone_number": "626-231-9465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11467 VIA LAGOS",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543851",
"telephone_number": "626-231-9465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANGKADJAJA",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-01-27",
"last_updated": "2026-01-27",
"certification_date": "2026-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95034134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.