=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790591758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LENAE'S LACTATION INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2024
-----------------------------------------------------
Last Update Date | 12/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 E STROTHER AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93706-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-202-3503
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1405 REDWOOD AVE
-----------------------------------------------------
City | ATWATER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95301-2723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-289-4495
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ILEISHA SANDERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-202-3503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------