Healthcare Provider Details

I. General information

NPI: 1689266611
Provider Name (Legal Business Name): AILEEN MORADIAN RN, MSN-ED, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 01/18/2023
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

4517 RANGER AVE
EL MONTE CA
91731-1527
US

V. Phone/Fax

Practice location:
  • Phone: 909-703-3079
  • Fax: 909-703-3582
Mailing address:
  • Phone: 909-703-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-106665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: