Healthcare Provider Details

I. General information

NPI: 1255288585
Provider Name (Legal Business Name): KAHO MONICA MATSUBARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7917 OSTROW ST STE A
SAN DIEGO CA
92111-3604
US

IV. Provider business mailing address

9051 MIRA MESA BLVD # 910848
SAN DIEGO CA
92126-2758
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-8282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20497
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: