Healthcare Provider Details

I. General information

NPI: 1902546906
Provider Name (Legal Business Name): LAWRENCE MATSUO OKUMOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45104 10TH ST W
LANCASTER CA
93534-2310
US

IV. Provider business mailing address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-7735
  • Fax: 503-494-4264
Mailing address:
  • Phone: 661-326-2200
  • Fax: 661-326-2950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA-201117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: