Provider Demographics
NPI:1598499667
Name:DIMMOCK, WENDY SUE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUE
Last Name:DIMMOCK
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:SUE
Other - Last Name:STORRS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10612 SENDA ACUARIO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8706
Mailing Address - Country:US
Mailing Address - Phone:414-817-4667
Mailing Address - Fax:
Practice Address - Street 1:2667 CAMINO DEL RIO S STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3733
Practice Address - Country:US
Practice Address - Phone:414-817-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-307385174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN