Basic Information
| Provider Information | |||||||||
| NPI: | 1851683379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATSUMURA | ||||||||
| FirstName: | AIKO | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1885 LUNDY AVE STE 223 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951311888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082849000 | ||||||||
| FaxNumber: | 4082849073 | ||||||||
| Practice Location | |||||||||
| Address1: | 1885 LUNDY AVE STE 223 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951311888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082849000 | ||||||||
| FaxNumber: | 4082849073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2011 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 80078 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.