Provider Demographics
NPI:1386894004
Name:MATSUURA, BRIANNA AIKO
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:AIKO
Last Name:MATSUURA
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 1:15 CAYUSE LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5155
Mailing Address - Country:US
Mailing Address - Phone:310-938-6573
Mailing Address - Fax:
Practice Address - Street 1:704 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3017
Practice Address - Country:US
Practice Address - Phone:310-938-6573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor