Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-26246 | CA |
NPI | 1104132893 |
---|---|
Provider Name | Mrs. Peggy Ann Reynolds |
First Address | Encinitas, CA 92024-4358 |
Second Address | Encinitas, CA 92024-4358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2010 |
Last Update Date | 03/04/2020 |