Provider Demographics
NPI:1003322306
Name:MATSUMOTO, KATHERINE LIN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LIN
Last Name:MATSUMOTO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 2768
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-5768
Mailing Address - Country:US
Mailing Address - Phone:657-241-3600
Mailing Address - Fax:657-241-7708
Practice Address - Street 1:250 E YALE LOOP STE 204
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4697
Practice Address - Country:US
Practice Address - Phone:949-732-3530
Practice Address - Fax:949-732-3533
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95007597OtherNURSE PRACTITIONER LICENSE