Provider Demographics
NPI:1184519886
Name:MURA, MASAYA F (CCAPP RADT)
Entity type:Individual
Prefix:MR
First Name:MASAYA
Middle Name:F
Last Name:MURA
Suffix:
Gender:M
Credentials:CCAPP RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 W 110TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4915
Mailing Address - Country:US
Mailing Address - Phone:213-718-4636
Mailing Address - Fax:
Practice Address - Street 1:1558 W 110TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-4915
Practice Address - Country:US
Practice Address - Phone:213-718-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)