=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669321535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN DIEGO LACTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2026
-----------------------------------------------------
Last Update Date | 01/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2848 CANTEGRA GLN
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-7347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-807-7229
-----------------------------------------------------
Fax | 760-267-9183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2848 CANTEGRA GLN
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-7347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-807-7229
-----------------------------------------------------
Fax | 760-267-9183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUISNESS OWNER
-----------------------------------------------------
Name | CORINNE BRESHEARS
-----------------------------------------------------
Credential | RN, IBCLC
-----------------------------------------------------
Telephone | 760-807-7229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WL0100X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Registered Nurse)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------