Healthcare Provider Details

I. General information

NPI: 1659402428
Provider Name (Legal Business Name): LILIAN FARJEAT SALCEDO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILIAN FARJEAT PSY.D

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 CHESAPEAKE DR STE. 206
SAN DIEGO CA
92123-1369
US

IV. Provider business mailing address

PO BOX 609001
SAN DIEGO CA
92160-9001
US

V. Phone/Fax

Practice location:
  • Phone: 619-814-6590
  • Fax: 619-814-6591
Mailing address:
  • Phone: 619-528-4600
  • Fax: 619-528-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: