Healthcare Provider Details

I. General information

NPI: 1790591758
Provider Name (Legal Business Name): LENAE'S LACTATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E STROTHER AVE
FRESNO CA
93706-3053
US

IV. Provider business mailing address

1405 REDWOOD AVE
ATWATER CA
95301-2723
US

V. Phone/Fax

Practice location:
  • Phone: 209-202-3503
  • Fax:
Mailing address:
  • Phone: 559-289-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ILEISHA SANDERS
Title or Position: PRESIDENT
Credential:
Phone: 209-202-3503