=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669361747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIANA AZZARA HESSELGESSER IBCLC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2025
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3150 EL CAMINO REAL STE G
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92008-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-231-1607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5333 AVENIDA DE LOS PINOS
-----------------------------------------------------
City | BONSALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92003-3731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-231-1607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number | L-319189
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------