Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-164785 | CA |
NPI | 1205466935 |
---|---|
Provider Name | Victoria Gellis |
First Address | San Diego, CA 92104-4620 |
Second Address | La Mesa, CA 91942-9322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2020 |
Last Update Date | 22/01/2020 |