Provider Demographics
NPI:1689188153
Name:LEILANI JEAN WILDE
Entity Type:Organization
Organization Name:LEILANI JEAN WILDE
Other - Org Name:BREASTFEEDING FIXERS AND LEILANI'S WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEILANI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-922-0808
Mailing Address - Street 1:2667 CAMINO DEL RIO S STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3733
Mailing Address - Country:US
Mailing Address - Phone:760-533-7953
Mailing Address - Fax:619-269-2676
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:760-533-7953
Practice Address - Fax:619-269-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty