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General NPI Number Information
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NPI Number | 1265940639
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Entity Type | Organization
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Legal Business Name | MATSUDA ACUPUNCTURE AND HERBAL MEDICINE, LLC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 894 E 100 N STE 2
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City | PRICE
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State | UT
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Zip | 84501-2711
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Country | US
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Telephone | 435-650-2302
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Fax | 435-304-6169
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Provider Business Mailing Address
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Address Line | 894 E 100 N STE 2
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City | PRICE
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State | UT
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Zip | 84501-2711
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Country | US
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Telephone | 435-650-2302
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Fax | 435-304-6169
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Authorized Official
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Title or Position | OWNER
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Name | LUKE T MATSUDA
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Credential | L.AC.
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Telephone | 435-650-2302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 9146400-1201
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License Number State | UT
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