Provider Demographics
NPI:1083752711
Name:MAYFIELD, SOFALA MTESA
Entity Type:Individual
Prefix:
First Name:SOFALA
Middle Name:MTESA
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 12TH AVE
Mailing Address - Street 2:APT.103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-3172
Mailing Address - Country:US
Mailing Address - Phone:510-261-0213
Mailing Address - Fax:
Practice Address - Street 1:525 5TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1012
Practice Address - Country:US
Practice Address - Phone:415-597-7977
Practice Address - Fax:415-597-7946
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)