Provider Demographics
NPI:1679539183
Name:MATHEW, CHETTUPUZHA JOSEPH (MD)
Entity type:Individual
Prefix:MR
First Name:CHETTUPUZHA
Middle Name:JOSEPH
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:C
Other - Middle Name:JOSEPH
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:AMN HEALTHCARE
Mailing Address - Street 2:12400 HIGH BLUFF DR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:978-857-1345
Mailing Address - Fax:310-318-1251
Practice Address - Street 1:AMN HEALTHCARE
Practice Address - Street 2:12400 HIGH BLUFF DR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:978-857-1345
Practice Address - Fax:310-318-1251
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine