Healthcare Provider Details

I. General information

NPI: 1598192601
Provider Name (Legal Business Name): NAOKO MATSUMOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 LOMITA BLVD STE 242
TORRANCE CA
90505-4815
US

IV. Provider business mailing address

3440 LOMITA BLVD STE 242
TORRANCE CA
90505-4815
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA128547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: