Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-49797 | CA |
NPI | 1326510876 |
---|---|
Provider Name | Alyssa Borrilez |
First Address | San Pedro, CA 90732-3237 |
Second Address | San Pedro, CA 90732-3237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2018 |
Last Update Date | 21/12/2018 |