Healthcare Provider Details

I. General information

NPI: 1639378714
Provider Name (Legal Business Name): JUNE LIANG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 PACIFIC HEIGHTS BLVD STE 150
SAN DIEGO CA
92121
US

IV. Provider business mailing address

9920 PACIFIC HEIGHTS BLVD STE 150
SAN DIEGO CA
92121-4361
US

V. Phone/Fax

Practice location:
  • Phone: 858-255-0357
  • Fax:
Mailing address:
  • Phone: 858-255-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY27986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: