Provider Demographics
NPI:1144308362
Name:OGAWA, YUMIKO
Entity type:Individual
Prefix:DR
First Name:YUMIKO
Middle Name:
Last Name:OGAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 WAYNE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3513
Mailing Address - Country:US
Mailing Address - Phone:201-332-5297
Mailing Address - Fax:
Practice Address - Street 1:6061 MISSION GORGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4007
Practice Address - Country:US
Practice Address - Phone:619-281-3706
Practice Address - Fax:619-281-3714
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20232101YP2500X
390200000X
NJ37PC 00469600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84975LOtherBLUE CROSS OF TX .