Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DC33670 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | DC33670 | CA |
NPI | 1336509025 |
---|---|
Provider Name | Leo Matsumoto |
First Address | Long Beach, CA 90806-2283 |
Second Address | Long Beach, CA 90806-2283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2016 |
Last Update Date | 19/02/2021 |