Healthcare Provider Details

I. General information

NPI: 1750417564
Provider Name (Legal Business Name): MARIE CHRISTINE LYSTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 THUNDER DR SUITE 203
VISTA CA
92083-6016
US

IV. Provider business mailing address

161 THUNDER DR SUITE 203
VISTA CA
92083-6016
US

V. Phone/Fax

Practice location:
  • Phone: 760-414-1567
  • Fax: 760-414-1771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC50737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: