Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1205475852 |
---|---|
Provider Name | Michelle Erin Jacobs |
First Address | Costa Mesa, CA 92627-1448 |
Second Address | Irvine, CA 92618-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2019 |
Last Update Date | 30/12/2019 |