Provider Demographics
NPI:1730213331
Name:ENOMOTO, YU
Entity type:Individual
Prefix:
First Name:YU
Middle Name:
Last Name:ENOMOTO
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 1:23502 LYONS AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2538
Mailing Address - Country:US
Mailing Address - Phone:661-286-2562
Mailing Address - Fax:661-222-7709
Practice Address - Street 1:23502 LYONS AVE STE 304
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2538
Practice Address - Country:US
Practice Address - Phone:661-286-2562
Practice Address - Fax:661-222-7709
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL