Healthcare Provider Details

I. General information

NPI: 1700464856
Provider Name (Legal Business Name): LILIANA DEL CARMEN RECALDE COUSINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY # 5018
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

3020 CHILDREN'S WAY, MAIL CODE 5018
SAN DIEGO CA
92123-4426
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-7759
  • Fax:
Mailing address:
  • Phone: 858-966-7759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA201579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: