Provider Demographics
NPI:1083326417
Name:BELL, CHARDA DENIECE (IBCLC)
Entity Type:Individual
Prefix:
First Name:CHARDA
Middle Name:DENIECE
Last Name:BELL
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 KINGS VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3351
Mailing Address - Country:US
Mailing Address - Phone:619-993-0362
Mailing Address - Fax:
Practice Address - Street 1:2108 KINGS VIEW CIR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-3351
Practice Address - Country:US
Practice Address - Phone:619-993-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X, 172V00000X, 261Q00000X, 374J00000X
CAL-309574174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No374J00000XNursing Service Related ProvidersDoula