MEDICARE: DR. MARIA AYA MATSUMOTO M.D.

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	174400000X	Specialist	G61382	CA
2	2085R0202X	Diagnostic Radiology Physician	G61382	CA

General Provider Information

NPI Number	:	1609812916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA AYA MATSUMOTO M.D.

Provider Business Mailing Address
First Line	:	2281 PARAGON DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1307
Country	:	US
Telephone Number	:	408-244-2100
Fax Number	:	408-244-6596

Provider Business Practice Location Address
First Line	:	2281 PARAGON DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1307
Country	:	US
Telephone Number	:	408-961-2649
Fax Number	:	408-244-6596

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	02/11/2015

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