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General NPI Number Information
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NPI Number | 1356146807
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Entity Type | Individual
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Provider Name | KAIA LACY CLC
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Gender | Female
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 721 NEVADA ST
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City | REDLANDS
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State | CA
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Zip | 92373-8079
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Country | US
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Telephone | 909-572-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 723 N AVENIDA CALMA
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City | TUCSON
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State | AZ
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Zip | 85745-2249
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Country | US
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Telephone | 520-955-1729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | 33054
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License Number State | MA
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