Healthcare Provider Details

I. General information

NPI: 1639925456
Provider Name (Legal Business Name): LORIE PATRICE SHIBA IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 DOLORES LN APT B
HUNTINGTON BEACH CA
92649-3341
US

IV. Provider business mailing address

16661 DOLORES LN APT B
HUNTINGTON BEACH CA
92649-3341
US

V. Phone/Fax

Practice location:
  • Phone: 714-287-6008
  • Fax:
Mailing address:
  • Phone: 714-287-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberC-33720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: