Provider Demographics
NPI:1568710135
Name:HENRY, FELICIA L (IBCLC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:L
Last Name:HENRY
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 1:295 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2422
Mailing Address - Country:US
Mailing Address - Phone:805-218-6156
Mailing Address - Fax:
Practice Address - Street 1:295 LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2422
Practice Address - Country:US
Practice Address - Phone:805-218-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10521621174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN