Provider Demographics
NPI:1184727588
Name:MIYAHARA, PATRICIA LOUISE (MFT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LOUISE
Last Name:MIYAHARA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:LOUISE
Other - Last Name:STRUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2423 CAMINO DEL RIO SOUTH
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3735
Mailing Address - Country:US
Mailing Address - Phone:619-295-5333
Mailing Address - Fax:619-220-0674
Practice Address - Street 1:2423 CAMINO DEL RIO SOUTH
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3735
Practice Address - Country:US
Practice Address - Phone:619-295-5333
Practice Address - Fax:619-220-0674
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT30057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist