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General NPI Number Information
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NPI Number | 1407165616
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Entity Type | Individual
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Provider Name | LEILANI WILDE PCD(DONA),CLC
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Gender | Female
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 13210 MEDALLION LN
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City | LAKESIDE
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State | CA
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Zip | 92040-5019
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Country | US
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Telephone | 619-922-0808
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Fax | 619-328-5995
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Provider Business Mailing Address
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Address Line | 13210 MEDALLION LN
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City | LAKESIDE
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State | CA
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Zip | 92040-5019
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Country | US
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Telephone | 619-922-0808
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Fax | 619-328-5995
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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 | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | 11155412
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License Number State | CA
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