Healthcare Provider Details

I. General information

NPI: 1154987253
Provider Name (Legal Business Name): TAMIKA SIMPSON PSYD, IBCLC, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMIKA BURGE

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27757 DOVER DR
MORENO VALLEY CA
92555-5757
US

IV. Provider business mailing address

27757 DOVER DR
MORENO VALLEY CA
92555-5757
US

V. Phone/Fax

Practice location:
  • Phone: 909-910-5876
  • Fax:
Mailing address:
  • Phone: 909-910-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number17546
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-115671
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberBBB183B177
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberBDC-CMTLYIFJ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: