Basic Information
| Provider Information | |||||||||
| NPI: | 1003154030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAUMAYA | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | KAISER | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17215 STUDEBAKER RD | ||||||||
| Address2: | STE # 180 | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628410348 | ||||||||
| FaxNumber: | 5644960484 | ||||||||
| Practice Location | |||||||||
| Address1: | 17215 STUDEBAKER RD | ||||||||
| Address2: | 180 | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628410348 | ||||||||
| FaxNumber: | 5644960484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2013 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 21540 | CA | N | Behavioral Health & Social Service Providers | Counselor | 106H00000X | 21540 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.