Healthcare Provider Details

I. General information

NPI: 1912153750
Provider Name (Legal Business Name): WINNIE J SUNSHINE CNM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMCSD 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134
US

IV. Provider business mailing address

719 MARSOLAN AVE
SOLANA BEACH CA
92075-1932
US

V. Phone/Fax

Practice location:
  • Phone: 619-218-1409
  • Fax:
Mailing address:
  • Phone: 619-300-2471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1819
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-34009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: