Healthcare Provider Details

I. General information

NPI: 1083326417
Provider Name (Legal Business Name): CHARDA DENIECE BELL IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 KINGS VIEW CIR
SPRING VALLEY CA
91977-3351
US

IV. Provider business mailing address

2108 KINGS VIEW CIR
SPRING VALLEY CA
91977-3351
US

V. Phone/Fax

Practice location:
  • Phone: 619-993-0362
  • Fax:
Mailing address:
  • Phone: 619-993-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-309574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: