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General NPI Number Information
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NPI Number | 1568115814
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Entity Type | Individual
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Provider Name | MRS. CHERIE ANN VISCONTI I
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Gender | Female
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 9 MANOR RD
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City | FAIRFAX
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State | CA
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Zip | 94930-1407
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Country | US
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Telephone | 415-509-6414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2031
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City | SAN ANSELMO
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State | CA
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Zip | 94979-2031
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-306128
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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-306128
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License Number State | CA
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