Active NPI
Maria Cecilia Matibag, RPH
- Pharmacist
- Glendale, CA
National Provider Identifier
1972028314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 69135
- Practice address
- 1400 W Kenneth Rd
Glendale, CA 91201-1422 - Phone
- (818) 242-4158
- Fax
- (818) 247-8593
- NPI assigned
- Aug 7, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 69135 | CA | Primary |
Addresses
Primary practice location
1400 W Kenneth Rd
Glendale, CA 91201-1422
Mailing address
3209 Community Ave
La Crescenta, CA 91214-2602
Phone (818) 642-6390
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPH69135 | Other | CA | PHARMACIST LISCENSE |
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 69135 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1972028314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3209 COMMUNITY AVE",
"city": "LA CRESCENTA",
"state": "CA",
"postal_code": "912142602",
"telephone_number": "818-642-6390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 W KENNETH RD",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912011422",
"telephone_number": "818-242-4158",
"fax_number": "818-247-8593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATIBAG",
"first_name": "MARIA",
"middle_name": "CECILIA",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-07",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "69135",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LISCENSE",
"identifier": "RPH69135",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.