Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11075190 | CA |
NPI | 1144629304 |
---|---|
Provider Name | Ms. Theresa M. Solis |
First Address | Goleta, CA 93117-1960 |
Second Address | Santa Barbara, CA 93110-1332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2014 |
Last Update Date | 13/08/2014 |