Healthcare Provider Details

I. General information

NPI: 1669386207
Provider Name (Legal Business Name): JESSICA A MILLER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 FOXWOOD DR
TRACY CA
95376-5313
US

IV. Provider business mailing address

1555 FOXWOOD DR
TRACY CA
95376-5313
US

V. Phone/Fax

Practice location:
  • Phone: 510-305-1314
  • Fax:
Mailing address:
  • Phone: 510-305-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-322178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: