Healthcare Provider Details

I. General information

NPI: 1316339724
Provider Name (Legal Business Name): SHARON CUTIN-BOTTOMLEY RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2015
Last Update Date: 02/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6654 BLEWETT AVE
LAKE BALBOA CA
91406-6010
US

IV. Provider business mailing address

6654 BLEWETT AVE
LAKE BALBOA CA
91406-6010
US

V. Phone/Fax

Practice location:
  • Phone: 818-388-1299
  • Fax:
Mailing address:
  • Phone: 818-388-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-56587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: