MEDICARE: LILIANA DEL CARMEN RECALDE COUSINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0804X	Child & Adolescent Psychiatry Physician	A201579	CA

General Provider Information

NPI Number	:	1700464856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIANA DEL CARMEN RECALDE COUSINS MD

Provider Business Mailing Address
First Line	:	3020 CHILDREN'S WAY, MAIL CODE 5018
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4426
Country	:	US
Telephone Number	:	858-966-7759
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 CHILDRENS WAY # 5018
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-966-7759
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	05/18/2026

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