Provider Demographics
NPI:1831264712
Name:STEWART, MASAKO YAJIMA (MA)
Entity type:Individual
Prefix:MRS
First Name:MASAKO
Middle Name:YAJIMA
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7817 HERSCHEL AVE
Mailing Address - Street 2:202
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4454
Mailing Address - Country:US
Mailing Address - Phone:619-847-9538
Mailing Address - Fax:619-303-3306
Practice Address - Street 1:5480 BALTIMORE DR
Practice Address - Street 2:250
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2020
Practice Address - Country:US
Practice Address - Phone:619-239-4663
Practice Address - Fax:619-239-3045
Is Sole Proprietor?:No
Enumeration Date:2006-11-23
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAMFC44787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health