Provider Demographics
NPI:1740201623
Name:MATSUNAGA, GARRETT S (MD)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:S
Last Name:MATSUNAGA
Suffix:
Gender:M
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:PO BOX 845996
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5996
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-221-5036
Practice Address - Street 1:20911 EARL ST STE 140
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4353
Practice Address - Country:US
Practice Address - Phone:310-542-0199
Practice Address - Fax:310-542-4652
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77838208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00728130OtherMEDICARE RAIL ROAD
CADG3479OtherMCRR GROUP PTAN
CAP00728130OtherMEDICARE RAIL ROAD
CA203177408OtherTAX ID
CAP00728130OtherMEDICARE RAIL ROAD