Provider Demographics
NPI:1669516381
Name:TOKUBO, JAMIE L (LAC,MSTOM)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:TOKUBO
Suffix:
Gender:F
Credentials:LAC,MSTOM
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:SHUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC MSTOM
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-0546
Mailing Address - Country:US
Mailing Address - Phone:858-436-7600
Mailing Address - Fax:760-797-1845
Practice Address - Street 1:906 SYCAMORE AVE STE 210
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7851
Practice Address - Country:US
Practice Address - Phone:858-436-7600
Practice Address - Fax:760-797-1845
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11199171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist