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General NPI Number Information
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NPI Number | 1093693954
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PSYCHOLOGY PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 7946 IVANHOE AVE STE 205
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City | LA JOLLA
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State | CA
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Zip | 92037-4517
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Country | US
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Telephone | 619-414-2810
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Fax |
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Provider Business Mailing Address
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Address Line | 7946 IVANHOE AVE STE 205
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City | LA JOLLA
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State | CA
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Zip | 92037-4517
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Country | US
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Telephone | 619-414-2810
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | OKSANA A LANIOUS
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Credential | PHD
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Telephone | 619-414-2810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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