NPI 1033738505 · live from the CMS NPI Registry
Xavier Al-Mateen
Student in an Organized Health Care Education/Training Program in Boise, ID. National Provider Identifier 1033738505, active.
NPI record
| NPI | 1033738505 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Student in an Organized Health Care Education/Training Program 390200000X |
| Practice location | 6348 W Emerald St, Boise, ID 83704 |
| Practice phone | 208-302-0900 |
| Mailing address | Po Box 190930, Boise, ID 83719 |
| Enumerated | April 14, 2020 |
| Last updated | May 23, 2024 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatry & Neurology, Psychiatry | 2084P0800X | M-17735 (ID) |
| Student in an Organized Health Care Education/Training Program primary | 390200000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.