MEDICARE: CORAL TOKUSHIGE

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	106S00000X	Behavior Technician
2	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1295459055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORAL TOKUSHIGE

Provider Business Mailing Address
First Line	:	3702 RUFFIN RD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1893
Country	:	US
Telephone Number	:	619-297-4300
Fax Number	:	619-297-4400

Provider Business Practice Location Address
First Line	:	3702 RUFFIN RD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1893
Country	:	US
Telephone Number	:	619-297-4300
Fax Number	:

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

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	03/17/2026

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Directions to “ CORAL TOKUSHIGE ” Practice Location

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