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General NPI Number Information
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NPI Number | 1932497229
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Entity Type | Organization
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Legal Business Name | MAVIS N MATSUMOTO, MD, LLC
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 870 SEVEN HILLS DR SUITE 102
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City | HENDERSON
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State | NV
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Zip | 89052-4377
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Country | US
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Telephone | 702-992-4050
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Fax | 702-992-4052
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Provider Business Mailing Address
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Address Line | 870 SEVEN HILLS DR SUITE 102
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City | HENDERSON
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State | NV
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Zip | 89052-4377
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Country | US
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Telephone | 702-992-4050
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Fax | 702-992-4052
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAVIS N MATSUMOTO
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Credential | M.D.
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Telephone | 702-992-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 7825
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License Number State | NV
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