MEDICARE: ANISSA NISHIRA CORNELIUS LM, CPM, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-314425
2	176B00000X	Midwife	765	CA

General Provider Information

NPI Number	:	1093067274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANISSA NISHIRA CORNELIUS LM, CPM, IBCLC

Provider Business Mailing Address
First Line	:	8550 GOLD COAST DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-3606
Country	:	US
Telephone Number	:	858-361-6392
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 FANUEL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2904
Country	:	US
Telephone Number	:	858-900-2004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	05/06/2025

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1164687257 — BUECHEL CHIROPRACTIC INC
Practice Location Address:

4535 FANUEL ST
SAN DIEGO, CA
92109-2904

Practice Phone: 858-866-6688
Practice Fax: 868-866-5644

1609262815 — ROBERT FREMONT D.D.S
Practice Location Address:

4527 FANUEL ST
SAN DIEGO, CA
92109-2904

Practice Phone: 858-272-2222
Practice Fax: 858-272-2414

1558747444 — DR. RACHEL HAMEL DC
Practice Location Address:

4535 FANUEL ST
SAN DIEGO, CA
92109-2904

Practice Phone: 858-775-5138
Practice Fax:

1477047678 — DR. CARLIANA CARPENTER DC
Practice Location Address:

4535 FANUEL ST
SAN DIEGO, CA
92109-2904

Practice Phone: 619-374-8444
Practice Fax:

1043859168 — TOURMALINE BIRTH AND WELLNESS COLLECTIVE
Practice Location Address:

4545 FANUEL ST
SAN DIEGO, CA
92109-2904

Practice Phone: 714-585-6197
Practice Fax:

Directions to “ ANISSA NISHIRA CORNELIUS LM, CPM, IBCLC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.