Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 126765 | CA |
NPI | 1114440872 |
---|---|
Provider Name | Kristen Margaret Davis |
First Address | Temecula, CA 92591-4562 |
Second Address | Temecula, CA 92591-4562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2017 |
Last Update Date | 24/07/2017 |