Provider Demographics
NPI:1659663623
Name:STIVERS, TARA (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:STIVERS
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 1:6930 QUITO CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8296
Mailing Address - Country:US
Mailing Address - Phone:805-504-3920
Mailing Address - Fax:
Practice Address - Street 1:6930 QUITO CT
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8296
Practice Address - Country:US
Practice Address - Phone:805-504-3920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11038193174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN