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KELLIE JOHNSON MATUSALEM MS PA-C NPI 1194121954


NPI Information

NPI: 1194121954
Provider Name: KELLIE JOHNSON MATUSALEM, MS, PA-C
Classification: Physician Assistant - 363A00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
3750 CONVOY ST STE 201
SAN DIEGO, CA
ZIP 92111
Phone: (858) 278-8300
Get Directions

Kellie Johnson Matusalem, MS, PA-C is a physician assistant in San Diego, CA. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. Kellie Johnson Matusalem, MS, PA-C NPI is 1194121954. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3750 CONVOY ST STE 201
SAN DIEGO, CA
ZIP 92111-770
Phone: (858) 278-8300

The NPI 1194121954 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/6/2014 and was last updated on 12/21/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363A00000XPhysician Assistant51956CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.