Etienne Jean de Dieu Matanda Matanda

Primary specialty

PharmacistTaxonomy code 183500000X

License

79185 Issued in CA

Practice address

14967 W Whitesbridge Ave
Kerman, CA 93630-1111

Phone

(559) 842-0030

NPI assigned

Jun 22, 2019

Last updated

Jun 22, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1561161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561161600000",
    "number": "1811558703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 S KONA AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937273481",
            "telephone_number": "254-366-1507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14967 W WHITESBRIDGE AVE",
            "city": "KERMAN",
            "state": "CA",
            "postal_code": "936301111",
            "telephone_number": "559-842-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATANDA MATANDA",
        "first_name": "ETIENNE",
        "middle_name": "JEAN DE DIEU",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-22",
        "last_updated": "2019-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "79185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Jeffery Luna, PA-C
• Mayra Maldonado
• Samit Mann
• Blanca Rosa Martinez-Ayala
• Adriana Torres Martinez
• Kulvinder Mattu
• Nekeitha Lyn McCauley, PHARM D.
• Alan Joseph Mendes, PT, DPT
• Ghassan Merrawi, RPH
• Sudhakar Nadipally, M.B.B.S.,M.P.H.,M.D.

• Pharmacist in Kerman, CA
• Providers in Kerman, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2019; 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.