Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-34952 | CA |
Y | 176B00000X | Midwife | LM558 | CA |
NPI | 1124395611 |
---|---|
Provider Name | Ms. Celest I. Winfrey |
First Address | Fontana, CA 92336-1244 |
Second Address | Fontana, CA 92336-1244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2011 |
Last Update Date | 05/03/2019 |