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NPI Code Detail

MEDICARE: IMAMURA MARRIAGE & FAMILY THERAPY, INC

MEDICARE: IMAMURA MARRIAGE & FAMILY THERAPY, INC
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1649114372
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMAMURA MARRIAGE & FAMILY THERAPY, INC
Provider Business Mailing Address
First Line : 3274 VIA MARIN
Second Line :
City : LA JOLLA
State : CA
Zip : 92037-2945
Country : US
Telephone Number : 858-848-5492
Fax Number : 858-750-1436
Provider Business Practice Location Address
First Line : 5252 BALBOA AVE STE 801
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-6970
Country : US
Telephone Number : 858-848-5492
Fax Number : 858-750-1436
Authorized Official
Title or Position : CEO
Name : KAYO IMAMURA
Credential :
Telephone Number : 619-587-4061
Provider Enumeration Date : 04/15/2026
Last Update Date : 04/15/2026

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Directions to “IMAMURA MARRIAGE & FAMILY THERAPY, INC ” Practice Location

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