Provider Demographics
NPI:1902202401
Name:DYER, MIKALIA (IBCLC)
Entity Type:Individual
Prefix:
First Name:MIKALIA
Middle Name:
Last Name:DYER
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 1:5923 CLARK RD STE F
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4866
Mailing Address - Country:US
Mailing Address - Phone:530-287-8222
Mailing Address - Fax:
Practice Address - Street 1:5923 CLARK RD STE F
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4866
Practice Address - Country:US
Practice Address - Phone:530-287-8222
Practice Address - Fax:530-237-0420
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-67172174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL-67172OtherIBLCE