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General NPI Number Information
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NPI Number | 1649020249
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Entity Type | Individual
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Provider Name | TRACY ALSUP RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 25255 CABOT RD STE 112
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5507
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Country | US
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Telephone | 505-944-5825
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Fax |
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Provider Business Mailing Address
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Address Line | 209 SKLAR ST
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City | LADERA RANCH
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State | CA
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Zip | 92694-0805
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Country | US
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Telephone | 505-944-5825
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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 | 834555
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License Number State | CA
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