Healthcare Provider Details

I. General information

NPI: 1225191034
Provider Name (Legal Business Name): JUSTIN A LAPILUSA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 1ST AVE
SAN DIEGO CA
92103-5816
US

IV. Provider business mailing address

9820 SHADOW RD
LA MESA CA
91941-4155
US

V. Phone/Fax

Practice location:
  • Phone: 619-400-9894
  • Fax:
Mailing address:
  • Phone: 619-400-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: