Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 25786 | CA |
Y | 103T00000X | Psychologist | 25786 | CA |
N | 103TC1900X | Counseling Psychologist | 25786 | CA |
NPI | 1043636525 |
---|---|
Provider Name | Fengqin Lian |
First Address | La Jolla, CA 92093-0304 |
Second Address | La Jolla, CA 92093-0304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2014 |
Last Update Date | 08/03/2014 |