Provider Demographics
NPI:1386521144
Name:MALFAVON, JOSHO RAY (LMFT)
Entity type:Individual
Prefix:
First Name:JOSHO
Middle Name:RAY
Last Name:MALFAVON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 RANCHO CARMEL DR STE 106
Mailing Address - Street 2:#1031
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4674
Mailing Address - Country:US
Mailing Address - Phone:858-633-6163
Mailing Address - Fax:
Practice Address - Street 1:11160 RANCHO CARMEL DR STE 106
Practice Address - Street 2:#1031
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4674
Practice Address - Country:US
Practice Address - Phone:858-633-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist