Provider Demographics
NPI:1629343447
Name:BLACKMON, DJUNA E (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:DJUNA
Middle Name:E
Last Name:BLACKMON
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 1:22650 TOWN DR APT 3
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-6657
Mailing Address - Country:US
Mailing Address - Phone:510-727-0572
Mailing Address - Fax:
Practice Address - Street 1:22650 TOWN DR APT 3
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-6657
Practice Address - Country:US
Practice Address - Phone:510-727-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11145861174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN