Healthcare Provider Details

I. General information

NPI: 1144308362
Provider Name (Legal Business Name): DR. YUMIKO OGAWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 MISSION GORGE RD SUITE 200
SAN DIEGO CA
92120-4007
US

IV. Provider business mailing address

83 WAYNE ST SUITE 302
JERSEY CITY NJ
07302-3513
US

V. Phone/Fax

Practice location:
  • Phone: 619-281-3706
  • Fax: 619-281-3714
Mailing address:
  • Phone: 201-332-5297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20232
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC 00469600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: