Basic Information
| Provider Information | |||||||||
| NPI: | 1831264712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | MASAKO | ||||||||
| MiddleName: | YAJIMA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7817 HERSCHEL AVE | ||||||||
| Address2: | 202 | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920374454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198479538 | ||||||||
| FaxNumber: | 6193033306 | ||||||||
| Practice Location | |||||||||
| Address1: | 5480 BALTIMORE DR | ||||||||
| Address2: | 250 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919422020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192394663 | ||||||||
| FaxNumber: | 6192393045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2006 | ||||||||
| LastUpdateDate: | 09/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | MFC44787 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.