1164235172 NPI number — JULIA MATSUMOTO BSN, RN, CCM

Table of content: JULIA MATSUMOTO BSN, RN, CCM (NPI 1164235172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164235172 NPI number — JULIA MATSUMOTO BSN, RN, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATSUMOTO
Provider First Name:
JULIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHIBAYAMA
Provider Other First Name:
JULIA
Provider Other Middle Name:
MATSUMOTO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164235172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404-1 KUMAGAWA
Provider Second Line Business Mailing Address:
MAISON MIYA 102
Provider Business Mailing Address City Name:
FUSSA
Provider Business Mailing Address State Name:
TOKYO
Provider Business Mailing Address Postal Code:
1970003
Provider Business Mailing Address Country Code:
JP
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 78
Provider Second Line Business Practice Location Address:
BUILDING 4408
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
42-552-2511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WA2000X , with the licence number:  95177278 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com