Healthcare Provider Details

I. General information

NPI: 1063047983
Provider Name (Legal Business Name): TAMESHA PATRICE VALVERDE IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4662 PRECISSI LN STE 200
STOCKTON CA
95207-6225
US

IV. Provider business mailing address

3175 ADMIRAL DR
STOCKTON CA
95209-1502
US

V. Phone/Fax

Practice location:
  • Phone: 209-751-3908
  • Fax:
Mailing address:
  • Phone: 209-688-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-34739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: