Healthcare Provider Details

I. General information

NPI: 1629120803
Provider Name (Legal Business Name): LAUREN E LIEFLAND PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 E 8TH ST STE 212
NATIONAL CITY CA
91950-2800
US

IV. Provider business mailing address

4081 STEPHENS ST
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-585-4651
  • Fax: 619-585-4692
Mailing address:
  • Phone: 619-785-5949
  • Fax: 619-785-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY14785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: