Provider Demographics
NPI:1902903925
Name:DOUGLASS, MAYUMI YAMANAKA
Entity Type:Individual
Prefix:MRS
First Name:MAYUMI
Middle Name:YAMANAKA
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MAYUMI
Other - Middle Name:
Other - Last Name:YAMANAKA VARELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 91193
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92169-3193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 3RD AVE STE 319
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1310
Practice Address - Country:US
Practice Address - Phone:619-691-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist