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NPI Code Detail

MEDICARE: JUNKO MASUTANI PA-C

MEDICARE: JUNKO MASUTANI PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA17396CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA17396OTHERCAPA LICENSE

General Provider Information

NPI Number : 1275751752
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUNKO MASUTANI PA-C
Provider Business Mailing Address
First Line : 3112 W. BEVERLY BLVD.
Second Line :
City : MONTEBELLO
State : CA
Zip : 90640
Country : US
Telephone Number : 323-726-3868
Fax Number : 323-728-3870
Provider Business Practice Location Address
First Line : 3112 WEST BEVERLY BLVD.
Second Line :
City : MONTEBELLO
State : CA
Zip : 90640-1537
Country : US
Telephone Number : 323-726-3868
Fax Number : 323-726-3870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 07/08/2007

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Directions to “ JUNKO MASUTANI PA-C” Practice Location

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