Healthcare Provider Details

I. General information

NPI: 1689194375
Provider Name (Legal Business Name): TUMINI SEKIBO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 ORANGE AVE STE 2
CORONADO CA
92118-2947
US

IV. Provider business mailing address

1339 ORANGE AVE STE 2
CORONADO CA
92118-2947
US

V. Phone/Fax

Practice location:
  • Phone: 619-554-0120
  • Fax:
Mailing address:
  • Phone: 619-693-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: