1386884658 NPI number — MS. MAYUMI MAE LACAYA SANTIAGO-SHUPE MS, MFT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386884658 NPI number — MS. MAYUMI MAE LACAYA SANTIAGO-SHUPE MS, MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTIAGO-SHUPE
Provider First Name:
MAYUMI MAE
Provider Middle Name:
LACAYA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386884658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 21022
Provider Second Line Business Mailing Address:
MAPLE RIDGE SQUARE RPO
Provider Business Mailing Address City Name:
MAPLE RIDGE
Provider Business Mailing Address State Name:
BRITISH COLUMBIA
Provider Business Mailing Address Postal Code:
V2X 1P7
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
778-386-2700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RPO DEWDENY TRUNK ROAD
Provider Second Line Business Practice Location Address:
MAPLE RIDGE SQUARE RPO
Provider Business Practice Location Address City Name:
MAPLE RIDGE
Provider Business Practice Location Address State Name:
BRITISH COLUMBIA
Provider Business Practice Location Address Postal Code:
V2X 1P7
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
778-386-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 32554 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)