Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L59289 | CA |
NPI | 1174920011 |
---|---|
Provider Name | Heather Shabestari |
First Address | San Diego, CA 92120-3943 |
Second Address | San Diego, CA 92120-3943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2014 |
Last Update Date | 13/01/2015 |