Provider Demographics
NPI:1588722334
Name:KUBOTA, RIA TANZ (LMFT RN)
Entity type:Individual
Prefix:MS
First Name:RIA
Middle Name:TANZ
Last Name:KUBOTA
Suffix:
Gender:F
Credentials:LMFT RN
Other - Prefix:MRS
Other - First Name:RIA
Other - Middle Name:TANZ
Other - Last Name:KUBOTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT RN
Mailing Address - Street 1:901 NEVIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3143
Mailing Address - Country:US
Mailing Address - Phone:510-307-2425
Mailing Address - Fax:510-307-2750
Practice Address - Street 1:901 NEVIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3143
Practice Address - Country:US
Practice Address - Phone:510-307-2425
Practice Address - Fax:510-307-2750
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32880101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist