NPI 1902174741

Mavis N Matsumoto, MD, LLC

Organisation Non-Pharmacy Dispensing Site Henderson, NV

Practice location

Address: 2780 W Horizon Ridge Pkwy Suite 30, Henderson, NV 89052-3995
Phone: (702) 992-4050
Mailing address: 2980 N Beverly Glen Cir Suite 301, Los Angeles, CA 90077-1726

Authorised official

Name: Mavis Matsumoto
Title: Owner
Phone: (702) 992-4050

Registered specialties

Non-Pharmacy Dispensing Site Primary

Suppliers Taxonomy 332900000X

Other Non-Pharmacy Dispensing Site providers in Nevada →

Registry record

NPI: 1902174741
Entity type: Organization
NPI issued: 8 Dec 2011
Record last updated: 15 Apr 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.