Provider Demographics
NPI:1861744302
Name:TOKUSATO, KARLA DOMINGUEZ (RAS)
Entity type:Individual
Prefix:MISS
First Name:KARLA
Middle Name:DOMINGUEZ
Last Name:TOKUSATO
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N EL CAMINO REAL
Mailing Address - Street 2:SPC 93
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1755
Mailing Address - Country:US
Mailing Address - Phone:310-270-0663
Mailing Address - Fax:
Practice Address - Street 1:504 W VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5704
Practice Address - Country:US
Practice Address - Phone:760-940-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-T1010011520101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)