Healthcare Provider Details

I. General information

NPI: 1750166765
Provider Name (Legal Business Name): ILEISHA SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
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 TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: