Healthcare Provider Details

I. General information

NPI: 1629634837
Provider Name (Legal Business Name): KRISTA TARANTINO RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 SAN ANDRES ST
SANTA BARBARA CA
93101-4013
US

IV. Provider business mailing address

1726 SAN ANDRES ST
SANTA BARBARA CA
93101-4013
US

V. Phone/Fax

Practice location:
  • Phone: 970-596-4139
  • Fax:
Mailing address:
  • Phone: 970-596-4139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number95037279
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-149277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: