Provider Demographics
NPI:1114440872
Name:DAVIS, KRISTEN MARGARET (IBCLC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARGARET
Last Name:DAVIS
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 1:39351 OAK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4562
Mailing Address - Country:US
Mailing Address - Phone:760-716-6699
Mailing Address - Fax:
Practice Address - Street 1:39351 OAK CLIFF DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4562
Practice Address - Country:US
Practice Address - Phone:760-716-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126765174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN