Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-305245 | CA |
NPI | 1376202408 |
---|---|
Provider Name | Meghan Seperack |
First Address | Carlsbad, CA 92009-8677 |
Second Address | La Mesa, CA 91942-9322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2021 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L-305245 | IBCLC (01) | CA |