Basic Information
| Provider Information | |||||||||
| NPI: | 1386682763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIFLYANDSKY | ||||||||
| FirstName: | OLEG | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 E HILLCREST DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913607790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106360044 | ||||||||
| FaxNumber: | 3107743676 | ||||||||
| Practice Location | |||||||||
| Address1: | 12450 VAN NUYS BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913311393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188961161 | ||||||||
| FaxNumber: | 8188965069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A63656 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 00A636560 | 05 | CA | MEDICAID | 7420 | 05 | CA | MEDICAID | 010580047 | 01 | CA | BLUE CROSS | OTHER | 7068 | 05 | CA | MEDICAID | 260052460 | 01 | CA | RAILROAD MEDICARE | OTHER | 6758 | 05 | CA | MEDICAID |