MEDICARE: KENTARO NOGUCHI MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	92408	CA
2	106H00000X	Marriage & Family Therapist	IMF84509	CA

General Provider Information

NPI Number	:	1043464985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENTARO NOGUCHI MA

Provider Business Mailing Address
First Line	:	5694 MISSION CENTER RD STE 602-892
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4355
Country	:	US
Telephone Number	:	619-909-7639
Fax Number	:	619-297-4496

Provider Business Practice Location Address
First Line	:	5694 MISSION CENTER RD STE 602-892
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4355
Country	:	US
Telephone Number	:	619-909-7639
Fax Number	:	619-815-4254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	08/31/2024

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Directions to “ KENTARO NOGUCHI MA” Practice Location

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