Provider Demographics
NPI:1619178365
Name:KAWAHARA, DEBRA MIDORI (PHD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MIDORI
Last Name:KAWAHARA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS REY
Mailing Address - State:CA
Mailing Address - Zip Code:92068-0074
Mailing Address - Country:US
Mailing Address - Phone:858-268-9054
Mailing Address - Fax:858-635-4585
Practice Address - Street 1:10455 POMERADO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1717
Practice Address - Country:US
Practice Address - Phone:858-268-9054
Practice Address - Fax:858-635-4585
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15540103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical