Provider Demographics
NPI:1861089880
Name:MISOURIA, LONA RENEE
Entity type:Individual
Prefix:MRS
First Name:LONA
Middle Name:RENEE
Last Name:MISOURIA
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 1:8910 CLAIREMONT MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1104
Mailing Address - Country:US
Mailing Address - Phone:858-514-5144
Mailing Address - Fax:858-514-5195
Practice Address - Street 1:4990 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7409
Practice Address - Country:US
Practice Address - Phone:619-668-4265
Practice Address - Fax:619-668-4264
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT122902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist