Provider Demographics
NPI:1760728976
Name:JOHNSON, MEGHAN (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2192 DERBY ST
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3306
Mailing Address - Country:US
Mailing Address - Phone:805-312-9112
Mailing Address - Fax:
Practice Address - Street 1:2192 DERBY ST
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3306
Practice Address - Country:US
Practice Address - Phone:805-312-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN