MEDICARE: DR. JAMES MATSUBA

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
1	183500000X	Pharmacist	25412	CA

General Provider Information

NPI Number	:	1285764696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MATSUBA

Provider Business Mailing Address
First Line	:	35254 CAMINO CAPISTRANO
Second Line	:
City	:	CAPISTRANO BEACH
State	:	CA
Zip	:	92624-1802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 CAMINO DE LOS MARES STE 101
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-2840
Country	:	US
Telephone Number	:	949-496-0123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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