Provider Demographics
NPI:1871535252
Name:FREITAS, MATTHEW F (FNP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:F
Last Name:FREITAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 MCHENRY AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-522-9054
Mailing Address - Fax:209-550-5898
Practice Address - Street 1:2501 MCHENRY AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-522-9054
Practice Address - Fax:209-550-5898
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MF0527309OtherDEA
CAZZZ26136ZMedicare ID - Type UnspecifiedPRACTICE NUMBER
R23502Medicare UPIN