Healthcare Provider Details

I. General information

NPI: 1184389736
Provider Name (Legal Business Name): LIVING LOTUS FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 ROSECRANS PL STE 202
SAN DIEGO CA
92110-4822
US

IV. Provider business mailing address

3065 ROSECRANS PL STE 202
SAN DIEGO CA
92110-4822
US

V. Phone/Fax

Practice location:
  • Phone: 858-522-9415
  • Fax:
Mailing address:
  • Phone: 858-522-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PANICHA MCGUIRE
Title or Position: CEO
Credential: PSYD, LMFT, RPT
Phone: 858-522-9415