Provider Demographics
NPI:1679841886
Name:WATSON, LEANNA MOORE (IBCLC)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:MOORE
Last Name:WATSON
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 1:300 N SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 N R ST
Practice Address - Street 2:PUBLIC HEALTH DEPARTMENT
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5226
Practice Address - Country:US
Practice Address - Phone:805-737-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11191131174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN