Healthcare Provider Details

I. General information

NPI: 1831264712
Provider Name (Legal Business Name): MASAKO YAJIMA STEWART M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 BALTIMORE DR 250
LA MESA CA
91942-2020
US

IV. Provider business mailing address

7817 HERSCHEL AVE 202
LA JOLLA CA
92037-4454
US

V. Phone/Fax

Practice location:
  • Phone: 619-239-4663
  • Fax: 619-239-3045
Mailing address:
  • Phone: 619-847-9538
  • Fax: 619-303-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC44787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: