Doctor Name: | DR. LILYA KRUGLYANSKY REISS |
NPI Number: | 1043335524 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | PSY17215 |
Business Practice Address: | 26381 Crown Valley Pkwy Suite 200 Mission Viejo, CA - 926916368 |
Business Phone Number: | 9493746550 |
Business Fax Number: | 9499166245 |
Mailing Address: | 26381 Crown Valley Pkwy, Suite 200 MISSION VIEJO |
State: | CA |
Postal Code: | 926916368 |
Phone Number: | 9493746550 |
Fax Number: | 9499166245 |
NPI Enumeration Date: | 03/21/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY17215 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |