Healthcare Provider Details

I. General information

NPI: 1093433716
Provider Name (Legal Business Name): HIROE MATSUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 SAWTELLE BLVD 307
LOS ANGELES CA
90025
US

IV. Provider business mailing address

269 S BEVERLY DR # 739
BEVERLY HILLS CA
90212-3851
US

V. Phone/Fax

Practice location:
  • Phone: 310-383-2905
  • Fax:
Mailing address:
  • Phone: 310-383-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number80100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: