Provider Demographics
NPI:1164290201
Name:ATIENZA, PRINCESS ELIZ SEGALA (IBCLC)
Entity Type:Individual
Prefix:
First Name:PRINCESS ELIZ
Middle Name:SEGALA
Last Name:ATIENZA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:PRINCESS ELIZ
Other - Middle Name:SEGALA
Other - Last Name:CERVANTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14688 VIA FIESTA
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3879
Mailing Address - Country:US
Mailing Address - Phone:619-952-0335
Mailing Address - Fax:
Practice Address - Street 1:14688 VIA FIESTA
Practice Address - Street 2:UNIT 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3879
Practice Address - Country:US
Practice Address - Phone:619-952-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-314464174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN