Provider Demographics
NPI:1811130578
Name:SUEOKA, REGINA (MFT)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:SUEOKA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MOORPARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1703
Mailing Address - Country:US
Mailing Address - Phone:408-836-7121
Mailing Address - Fax:408-249-9204
Practice Address - Street 1:4100 MOORPARK AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1703
Practice Address - Country:US
Practice Address - Phone:408-836-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42583106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist