Provider Demographics
NPI:1144032418
Name:MATOVU, EDWARD GEORGE
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:GEORGE
Last Name:MATOVU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 W OLYMPIC BLVD STE 11150W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1817
Mailing Address - Country:US
Mailing Address - Phone:510-397-2851
Mailing Address - Fax:
Practice Address - Street 1:11150 W OLYMPIC BLVD STE 11150W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1817
Practice Address - Country:US
Practice Address - Phone:510-397-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician