MEDICARE: HAILEY SIERRA WADA RN, 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	163W00000X	Registered Nurse	RN95289205	CA
2	163WL0100X	Lactation Consultant (Registered Nurse)	L-321051	CA

General Provider Information

NPI Number	:	1548129497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY SIERRA WADA RN, IBCLC

Provider Business Mailing Address
First Line	:	5940 OAK AVE
Second Line	:	#1115
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780
Country	:	US
Telephone Number	:	626-268-1556
Fax Number	:

Provider Business Practice Location Address
First Line	:	6849 SPRINGVIEW PL
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-4893
Country	:	US
Telephone Number	:	909-331-1448
Fax Number	:

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

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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