Provider Information for 1790436905
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YUKO MATSUSHIMA
Sex: Female
NPI: 1790436905
Last Updated: 2022-01-10
Certification Date: 2022-01-10
Certification Date: 2022-01-10
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1790436905 | ||||||||
| Enumeration Date | 2022-01-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 214 KING ST NACOGDOCHES, TX 75961-4468 United States Phone: 936-371-0488 | Fax: | ||||||||
| Primary Practice Address | 214 KING ST NACOGDOCHES, TX 75961-4468 United States Phone: 936-371-0488 | Fax: | ||||||||
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