Healthcare Provider Details

I. General information

NPI: 1588587752
Provider Name (Legal Business Name): ERNEST MAKOTO MATTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PBS, 205 E SPOKANE FALLS BLVD
SPOKANE WA
99202
US

IV. Provider business mailing address

16801 E MISSION PKWY APT M305
SPOKANE VALLEY WA
99216-5115
US

V. Phone/Fax

Practice location:
  • Phone: 509-368-6700
  • Fax:
Mailing address:
  • Phone: 360-334-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: