Provider Demographics
NPI:1548353121
Name:LUXENBERG, MATTHEW BART (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BART
Last Name:LUXENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 KATELLA AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-598-8593
Mailing Address - Fax:562-594-0877
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-598-8593
Practice Address - Fax:562-594-0877
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61964174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE89963Medicare UPIN