MEDICARE: RYOKO MUTA LCSW

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	1041C0700X	Clinical Social Worker	LCSW80617	CA

General Provider Information

NPI Number	:	1578810107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYOKO MUTA LCSW

Provider Business Mailing Address
First Line	:	1250 MORENA BLVD FL 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3815
Country	:	US
Telephone Number	:	619-692-8750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 MORENA BLVD FL 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3815
Country	:	US
Telephone Number	:	619-692-8750
Fax Number	:

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

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	12/12/2025

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Directions to “ RYOKO MUTA LCSW” Practice Location

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