Healthcare Provider Details

I. General information

NPI: 1184374365
Provider Name (Legal Business Name): LAUREN KIEVA MATSUNO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 TAMPA AVE
RESEDA CA
91335-3700
US

IV. Provider business mailing address

7150 TAMPA AVE
RESEDA CA
91335-3700
US

V. Phone/Fax

Practice location:
  • Phone: 818-774-8444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA188576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: