Provider Demographics
NPI:1871392878
Name:RASMUSSEN, MISA C
Entity type:Individual
Prefix:
First Name:MISA
Middle Name:C
Last Name:RASMUSSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 TORREY CIR APT S306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6680
Mailing Address - Country:US
Mailing Address - Phone:916-955-3221
Mailing Address - Fax:
Practice Address - Street 1:19600 CULL CANYON RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-3715
Practice Address - Country:US
Practice Address - Phone:916-955-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health