Healthcare Provider Details

I. General information

NPI: 1235156209
Provider Name (Legal Business Name): LISA TODD EYLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151B MAIL CODE 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

151B MAIL CODE 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax:
Mailing address:
  • Phone: 858-552-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: