Provider Demographics
NPI:1114778511
Name:MATSUYAMA, NORIKA
Entity Type:Individual
Prefix:
First Name:NORIKA
Middle Name:
Last Name:MATSUYAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25-1 OKAMACHI
Mailing Address - Street 2:
Mailing Address - City:MORIYAMA
Mailing Address - State:JAPAN
Mailing Address - Zip Code:5240032
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25-1 OKAMACHI
Practice Address - Street 2:
Practice Address - City:MORIYAMA
Practice Address - State:JAPAN
Practice Address - Zip Code:5240032
Practice Address - Country:JP
Practice Address - Phone:209-455-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer