Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 10921004 | CA |
NPI | 1285985622 |
---|---|
Provider Name | Teresa Lynn Dillen Massillon |
First Address | San Francisco, CA 94110-4935 |
Second Address | San Francisco, CA 94110-4935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 25/09/2012 |