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MARC S MATSUMURA
>> Organized Health Care Education/Training Program >> StudentRegistrant NPI Number: 1124695952
Individual Registrant: MARC S MATSUMURA
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
1087 W EARLY LIGHT WAY BLUFFDALE, UT 84065-1880 US
Tel: 801-231-0277 Fax: --
Tel: 801-231-0277 Fax: --
Contact information for business:
1087 W EARLY LIGHT WAY BLUFFDALE, UT 84065-1880 US
Tel: 801-231-0277 Fax: --
Tel: 801-231-0277 Fax: --
Registration Information:
NPI: 1124695952
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 390200000X | Student Organized Health Care Education/Training Program |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
