Healthcare Provider Details

I. General information

NPI: 1225047475
Provider Name (Legal Business Name): JULIE B LALOR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8772 CUYAMACA ST SUITE 104
SANTEE CA
92071-4218
US

IV. Provider business mailing address

8772 CUYAMACA ST SUITE 104
SANTEE CA
92071-4218
US

V. Phone/Fax

Practice location:
  • Phone: 619-600-7658
  • Fax: 619-448-8586
Mailing address:
  • Phone: 619-600-7658
  • Fax: 619-448-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 19986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: