Healthcare Provider Details

I. General information

NPI: 1457036675
Provider Name (Legal Business Name): KAVISA WOOD IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 ARCHCREST WAY
SACRAMENTO CA
95835-1641
US

IV. Provider business mailing address

5108 ARCHCREST WAY
SACRAMENTO CA
95835-1641
US

V. Phone/Fax

Practice location:
  • Phone: 916-572-4433
  • Fax:
Mailing address:
  • Phone: 916-572-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: