Provider Demographics
NPI:1699009589
Name:KONOVALOVA, LANA
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:KONOVALOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 C STREET # 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2056
Mailing Address - Country:US
Mailing Address - Phone:818-429-9933
Mailing Address - Fax:
Practice Address - Street 1:7339 EL CAJON BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941
Practice Address - Country:US
Practice Address - Phone:818-429-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist