Healthcare Provider Details

I. General information

NPI: 1306113881
Provider Name (Legal Business Name): SERENA F MEYER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 MARTIS CT
EL SOBRANTE CA
94803-3441
US

IV. Provider business mailing address

5425 MARTIS COURT
EL SOBRANTE CA
94803
US

V. Phone/Fax

Practice location:
  • Phone: 510-612-4000
  • Fax: 510-213-6680
Mailing address:
  • Phone: 510-612-4000
  • Fax: 510-275-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number95048954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: