| Doctor Name: | OLGA LYSSANOVA |
| NPI Number: | 1457791451 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 3666 Kearny Villa Rd Suite #225 San Diego, CA - 921231951 |
| Business Phone Number: | 8585055480 |
| Business Fax Number: | |
| Mailing Address: | 3666 Kearny Villa Rd, Suite #225 SAN DIEGO |
| State: | CA |
| Postal Code: | 921231951 |
| Phone Number: | 8585055480 |
| Fax Number: | |
| NPI Enumeration Date: | 07/05/2013 |
| NPI Last Update Date: | 07/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals who are trained on a specific piece of equipment or technical procedure. |