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MAVIS N MATSUMOTO, MD, LLC
NPI 1902174741
Non-Pharmacy Dispensing Site in Henderson, NV

Active since December 08, 2011CLIA 29D1010709 · Waiver
2780 W HORIZON RIDGE PKWY, SUITE 30, HENDERSON, NV 89052(702) 992-4050 Get Directions Write a Review

NPPES record last updated: April 15, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mavis N Matsumoto, Md, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAVIS N MATSUMOTO, MD, LLC (NPI 1902174741) is a healthcare organization registered as a non-pharmacy dispensing site in Henderson, Nevada and active in the NPI registry since December 2011. The organization holds a CLIA Waiver certificate valid through March 20, 2027 and lists Mavis Matsumoto, Owner, as its authorized official.

NPPES Registry Identity

NPI1902174741
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameMAVIS N MATSUMOTO, MD, LLC
Location Address2780 W HORIZON RIDGE PKWY, SUITE 30Henderson, NV 89052-3995
Mailing Address2980 N Beverly Glen Cir, Suite 301Los Angeles, CA 90077-1726 · (310) 474-9809
Phone(702) 992-4050
Organization SubpartYes
Authorized OfficialMavis MatsumotoOwner · (702) 992-4050
Enumeration DateDecember 8, 2011
Last NPPES UpdateApril 15, 2013
✔ NPI 1902174741 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
Definition
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
2780 W HORIZON RIDGE PKWY, Henderson, NV 89052
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 29D1010709

Mavis N Matsumoto, MD, LLC · Henderson, NV
Active · expires Mar 20, 2027
CLIA Number29D1010709
Laboratory TypePhysician Office
Certificate Effective DateMarch 21, 2025
Certificate Expiration DateMarch 20, 2027
Laboratory DirectorMavis N. Matsumoto MD
Laboratory Phone(702) 992-4050
Laboratory LocationMavis N Matsumoto, MD, LLC2780 Horizon Ridge Pkwy Ste 30, Henderson, NV 89052
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JAMIE PERO OTR/L
Occupational Therapist (Pediatrics)
2780 W HORIZON RIDGE PKWY, SUITE 40
HENDERSON, NV 89052
Clark County (702) 564-4116
MARIFLOYD WRIGHT S.T.
Speech-Language Pathologist
2780 W HORIZON RIDGE PKWY, STE 40
HENDERSON, NV 89052
Clark County (702) 564-4116
DR. ASHLEY MICHELLE ANDERSON DMD
Dentist (General Practice)
2780 W HORIZON RIDGE PKWY, SUITE 20
HENDERSON, NV 89052
Clark County (702) 719-4700
MR. JEREMY THOMPSON P.T,
Occupational Therapist (Pediatrics)
2780 W HORIZON RIDGE PKWY, STE 40
HENDERSON, NV 89052
Clark County (702) 564-4116
DEVON A ALLGOWER P.T.
Physical Therapist (Pediatrics)
2780 W HORIZON RIDGE PKWY, SUITE 40
HENDERSON, NV 89052
Clark County (702) 737-0304
DR. MAVIS N MATSUMOTO M.D.
Internal Medicine
2780 W HORIZON RIDGE PKWY, SUITE 30
HENDERSON, NV 89052
Clark County (702) 992-4050

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mavis N Matsumoto, MD, LLC's NPI number?

The NPI number for Mavis N Matsumoto, MD, LLC is 1902174741. It was assigned to this organization in the NPPES registry on December 8, 2011.

Where is Mavis N Matsumoto, MD, LLC located?

Mavis N Matsumoto, MD, LLC is located at 2780 W Horizon Ridge Pkwy Suite 30, Henderson, NV 89052. The listed phone number is (702) 992-4050.

What is Mavis N Matsumoto, MD, LLC's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

Does Mavis N Matsumoto, MD, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 29D1010709) is associated with this NPI, valid through March 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mavis N Matsumoto, MD, LLC was last updated on April 15, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.