Healthcare Provider Details

I. General information

NPI: 1710279070
Provider Name (Legal Business Name): CLEAR INSIGHT PSYCHIATRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 MIRAMAR RD SUITE 315
SAN DIEGO CA
92126-4560
US

IV. Provider business mailing address

15561 VIA LA VENTANA
SAN DIEGO CA
92131-4316
US

V. Phone/Fax

Practice location:
  • Phone: 858-354-1304
  • Fax:
Mailing address:
  • Phone: 858-354-1304
  • Fax: 858-566-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA96420
License Number StateCA

VIII. Authorized Official

Name: DR. LI LIANG
Title or Position: CEO
Credential: M.D.
Phone: 858-354-1304