Vadym Matusov

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

95070466 Issued in CA

Practice address

1904 Richland Ave
Ceres, CA 95307-4562

Phone

(209) 300-8800

NPI assigned

Jul 24, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1265817811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 S ROSE ST",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953805531",
            "telephone_number": "818-599-6960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 RICHLAND AVE",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953074562",
            "telephone_number": "209-300-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATUSOV",
        "first_name": "VADYM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-24",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN 235920",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95070466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiny Marquez
• Karenna Nicole Martin, MS
• Marcus Martinez, ACSW
• Stephanie Anne Marie Mast
• John Richard Mataka, RAS
• Giovanni Maya
• Fanta Mboka
• Daniel Eric McCoy
• Tracey McCullough
• Constance McDonald

• Psychiatric/Mental Health Registered Nurse in Ceres, CA
• Providers in Ceres, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.