Healthcare Provider Details

I. General information

NPI: 1194629980
Provider Name (Legal Business Name): BONITA ANN BROUGHTON IBCLC, ICBD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23601 GREER RD
MURRIETA CA
92562-4560
US

IV. Provider business mailing address

23601 GREER RD
MURRIETA CA
92562-4560
US

V. Phone/Fax

Practice location:
  • Phone: 540-850-9692
  • Fax:
Mailing address:
  • Phone: 540-850-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: