Provider Demographics
NPI:1124241070
Name:OLIN, MATTHEW SIDNEY (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SIDNEY
Last Name:OLIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24520 HAWTHORNE BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6849
Mailing Address - Country:US
Mailing Address - Phone:310-300-6206
Mailing Address - Fax:310-919-3703
Practice Address - Street 1:24520 HAWTHORNE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6849
Practice Address - Country:US
Practice Address - Phone:310-300-6206
Practice Address - Fax:310-919-3703
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18578363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant