| Matthew Fava | |
|
404 W Pine St Lodi CA 95240-2048 | |
| (209) 769-9554 | |
| (209) 435-0894 |
| Full Name | Matthew Fava |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 404 W Pine St, Lodi, California |
| Authorized Official Name and Position | Matthew Joseph Fava (DOCTOR) |
| Authorized Official Contact | 2097699554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Matthew Fava 507 Yokuts Dr Lodi CA 95240-0690 Ph: (209) 769-9554 | Matthew Fava 404 W Pine St Lodi CA 95240-2048 Ph: (209) 769-9554 |
| NPI Number | 1821117284 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 04/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821117284 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 47392 (California) | Primary |
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