Healthcare Provider Details

I. General information

NPI: 1518365022
Provider Name (Legal Business Name): LEAH DE SHAY IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BELLFLOWER BLVD #112
LONG BEACH CA
90815
US

IV. Provider business mailing address

21832 S EMBASSY AVE
CARSON CA
90810-1739
US

V. Phone/Fax

Practice location:
  • Phone: 714-884-9272
  • Fax:
Mailing address:
  • Phone: 714-884-9272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-67984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: