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General NPI Number Information
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NPI Number | 1508717216
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Entity Type | Individual
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Provider Name | JESSICA BLAIR SIMANDJUNTAK RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2026
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Last Update Date | 02/07/2026
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Provider Practice Location Address
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Address Line | 151 ORANGE PARK
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City | REDLANDS
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State | CA
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Zip | 92374-5543
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Country | US
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Telephone | 909-810-8188
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Fax |
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Provider Business Mailing Address
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Address Line | 151 ORANGE PARK
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City | REDLANDS
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State | CA
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Zip | 92374-5543
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Country | US
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Telephone |
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 95176001
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-308269
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License Number State | CA
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