Provider Demographics
NPI:1558980920
Name:SOCAL BREASTFEEDING LLC
Entity Type:Organization
Organization Name:SOCAL BREASTFEEDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IBCLC
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-922-2080
Mailing Address - Street 1:6441 MOUNT ADELBERT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3228
Mailing Address - Country:US
Mailing Address - Phone:619-922-2080
Mailing Address - Fax:
Practice Address - Street 1:6441 MOUNT ADELBERT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3228
Practice Address - Country:US
Practice Address - Phone:619-922-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty