Healthcare Provider Details

I. General information

NPI: 1457122301
Provider Name (Legal Business Name): JONATHAN GUILLERMO SHIROMA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 LA MESA BLVD STE 7
LA MESA CA
91942-6208
US

IV. Provider business mailing address

8280 LA MESA BLVD STE 7
LA MESA CA
91942-6208
US

V. Phone/Fax

Practice location:
  • Phone: 619-535-8709
  • Fax:
Mailing address:
  • Phone: 619-535-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165183
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: