Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1174882203 |
---|---|
Provider Name | Ms. Carmelita Jessie |
First Address | Oakland, CA 94605-2547 |
Second Address | Oakland, CA 94605-2547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2012 |
Last Update Date | 09/05/2012 |