Provider Demographics
NPI:1386682763
Name:LIFLYANDSKY, OLEG (MD)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:LIFLYANDSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E HILLCREST DR STE 240
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7790
Mailing Address - Country:US
Mailing Address - Phone:310-636-0044
Mailing Address - Fax:310-774-3676
Practice Address - Street 1:12450 VAN NUYS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1393
Practice Address - Country:US
Practice Address - Phone:818-896-1161
Practice Address - Fax:818-896-5069
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA636562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636560Medicaid
CA7420Medicaid
CA010580047OtherBLUE CROSS
CA7068Medicaid
CA260052460OtherRAILROAD MEDICARE
CA6758Medicaid