Active NPI
John D Matrisciano, MD
- Surgery Physician
- Thousand Oaks, CA
National Provider Identifier
1649389495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- G29825
- Practice address
- 2190 Lynn Rd
#200
Thousand Oaks, CA 91360 - Phone
- (805) 379-4677
- Fax
- (805) 495-1829
- NPI assigned
- Aug 29, 2006
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | G29825 | CA | Primary |
Addresses
Primary practice location
2190 Lynn Rd
#200
Thousand Oaks, CA 91360
Mailing address
2190 Lynn Rd
#200
Thousand Oaks, CA 91360
Phone (805) 379-4677
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237766400000",
"number": "1649389495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2190 LYNN RD",
"address_2": "#200",
"city": "THOUSAND OAKS",
"state": "CA",
"postal_code": "91360",
"telephone_number": "805-379-4677",
"fax_number": "805-495-1829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2190 LYNN RD",
"address_2": "#200",
"city": "THOUSAND OAKS",
"state": "CA",
"postal_code": "91360",
"telephone_number": "805-379-4677",
"fax_number": "805-495-1829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATRISCIANO",
"first_name": "JOHN",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2009-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "G29825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Thousand Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.