Provider Demographics
NPI:1700102274
Name:FUJITA, MATTHEW HARU (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:HARU
Last Name:FUJITA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:6860 BROCKTON AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3821
Practice Address - Country:US
Practice Address - Phone:951-534-0600
Practice Address - Fax:951-534-0605
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0271109OtherDEPT OF LABOR AND INDUSTRIES
WA0271109OtherDEPT OF LABOR AND INDUSTRIES
CAEC562YMedicare PIN