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General NPI Number Information
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NPI Number | 1295806065
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Entity Type | Individual
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Provider Name | STEPHANIE ELLEN EISCHEN-LEE PH.D
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 7060 CLAIREMONT MESA BLVD
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City | SAN DIEGO
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State | CA
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Zip | 92111-1003
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Country | US
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Telephone | 858-573-5447
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Fax | 858-573-5630
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Provider Business Mailing Address
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Address Line | 918 E AVE
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City | CORONADO
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State | CA
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Zip | 92118-2545
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Country | US
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Telephone | 619-435-0603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 19145
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License Number State | CA
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