Healthcare Provider Details

I. General information

NPI: 1003322306
Provider Name (Legal Business Name): KATHERINE LIN MATSUMOTO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE LIN FNP

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E YALE LOOP STE 204
IRVINE CA
92604-4697
US

IV. Provider business mailing address

PO BOX 2768
SUISUN CITY CA
94585-5768
US

V. Phone/Fax

Practice location:
  • Phone: 949-732-3530
  • Fax: 949-732-3533
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: