Healthcare Provider Details

I. General information

NPI: 1154155471
Provider Name (Legal Business Name): DENISE S TAYLOR RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 LUCIA CT
CARLSBAD CA
92009-8126
US

IV. Provider business mailing address

7733 LUCIA CT
CARLSBAD CA
92009-8126
US

V. Phone/Fax

Practice location:
  • Phone: 858-621-3396
  • Fax:
Mailing address:
  • Phone: 858-621-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number65162400
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number95162400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: