Provider Demographics
NPI:1679593412
Name:MATIKA, MARCIA (DPM)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:MATIKA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S SEPULVEDA BLVD
Mailing Address - Street 2:STE 303
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6977
Mailing Address - Country:US
Mailing Address - Phone:310-530-5729
Mailing Address - Fax:310-530-5707
Practice Address - Street 1:500 S SEPULVEDA BLVD
Practice Address - Street 2:STE 303
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6977
Practice Address - Country:US
Practice Address - Phone:310-530-5729
Practice Address - Fax:310-530-5707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3497213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3497BMedicare ID - Type Unspecified
CAT11827Medicare UPIN