Provider Demographics
NPI:1013041516
Name:MATSUDA, SAYO
Entity Type:Individual
Prefix:MRS
First Name:SAYO
Middle Name:
Last Name:MATSUDA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SAYO
Other - Middle Name:
Other - Last Name:MATSUDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 520446
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84152-0446
Mailing Address - Country:US
Mailing Address - Phone:424-235-0096
Mailing Address - Fax:
Practice Address - Street 1:108 W VICTORIA ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3523
Practice Address - Country:US
Practice Address - Phone:424-757-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT143675106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist