Provider Demographics
NPI:1609812916
Name:MATSUMOTO, MARIA AYA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:AYA
Last Name:MATSUMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1307
Mailing Address - Country:US
Mailing Address - Phone:408-244-2100
Mailing Address - Fax:408-244-6596
Practice Address - Street 1:2281 PARAGON DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1307
Practice Address - Country:US
Practice Address - Phone:408-961-2649
Practice Address - Fax:408-244-6596
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61382174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAX514SMedicare PIN
CAAX514WMedicare PIN
CAAX514YMedicare PIN
CAAX514VMedicare PIN
CA00G613820Medicare PIN
CA300110222Medicare PIN
CAAX514UMedicare PIN
CAAX514XMedicare PIN
CAAX514ZMedicare PIN
CAF86492Medicare UPIN
CAAX514TMedicare PIN