Provider Demographics
NPI:1114945359
Name:MALAY, PAULITA LASOLA (MS, MFT)
Entity Type:Individual
Prefix:MRS
First Name:PAULITA
Middle Name:LASOLA
Last Name:MALAY
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 EL CAMINO REAL AVE.
Mailing Address - Street 2:#211
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3439
Mailing Address - Country:US
Mailing Address - Phone:650-871-7717
Mailing Address - Fax:650-871-7717
Practice Address - Street 1:715 EL CAMINO REAL
Practice Address - Street 2:#211
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3426
Practice Address - Country:US
Practice Address - Phone:650-871-7717
Practice Address - Fax:650-871-7717
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT#33749106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist