Provider Demographics
NPI:1942586631
Name:MATSUSHIMA, GLENN R (CPO, FAAOP)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:R
Last Name:MATSUSHIMA
Suffix:
Gender:M
Credentials:CPO, FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 MYRTLE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2745
Mailing Address - Country:US
Mailing Address - Phone:562-595-6445
Mailing Address - Fax:562-424-3122
Practice Address - Street 1:2669 MYRTLE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2745
Practice Address - Country:US
Practice Address - Phone:562-595-6445
Practice Address - Fax:562-424-3122
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist