Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-115671 | CA |
NPI | 1154987253 |
---|---|
Provider Name | Tamika Simpson |
First Address | Moreno Valley, CA 92557-2743 |
Second Address | Moreno Valley, CA 92557-2743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2019 |
Last Update Date | 01/08/2020 |