Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 10910180 | CA |
NPI | 1083055917 |
---|---|
Provider Name | Jessica Lee |
First Address | Pittsburg, CA 94565-3700 |
Second Address | Pittsburg, CA 94565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2013 |
Last Update Date | 08/07/2013 |