Provider Demographics
NPI:1811252950
Name:MATSUO, SAMUEL I JR (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:I
Last Name:MATSUO
Suffix:JR
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 1:2301 N VICKIE CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6580
Mailing Address - Country:US
Mailing Address - Phone:808-391-6419
Mailing Address - Fax:
Practice Address - Street 1:2301 N VICKIE CT
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6580
Practice Address - Country:US
Practice Address - Phone:808-391-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143883208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation