Provider Demographics
NPI:1164235172
Name:MATSUMOTO, JULIA (BSN, RN, CCM)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MATSUMOTO
Suffix:
Gender:F
Credentials:BSN, RN, CCM
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MATSUMOTO
Other - Last Name:SHIBAYAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404-1 KUMAGAWA
Mailing Address - Street 2:MAISON MIYA 102
Mailing Address - City:FUSSA
Mailing Address - State:TOKYO
Mailing Address - Zip Code:1970003
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 78
Practice Address - Street 2:BUILDING 4408
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96328
Practice Address - Country:US
Practice Address - Phone:042-552-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95177278163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator