Provider Demographics
NPI:1356230064
Name:HAUKSDOTTIR, FRIDA (IBCLC)
Entity type:Individual
Prefix:
First Name:FRIDA
Middle Name:
Last Name:HAUKSDOTTIR
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:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:SILVERADO
Mailing Address - State:CA
Mailing Address - Zip Code:92676-0621
Mailing Address - Country:US
Mailing Address - Phone:949-600-0394
Mailing Address - Fax:
Practice Address - Street 1:30162 SILVERADO CANYON RD
Practice Address - Street 2:
Practice Address - City:SILVERADO
Practice Address - State:CA
Practice Address - Zip Code:92676-9838
Practice Address - Country:US
Practice Address - Phone:949-600-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59924225700000X
CAL-319052174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist