Provider Demographics
NPI:1922446897
Name:BRANTON, LISA (IBCLC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRANTON
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 1:5235 MISSION OAKS BLVD
Mailing Address - Street 2:#570
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5400
Mailing Address - Country:US
Mailing Address - Phone:805-484-4828
Mailing Address - Fax:805-484-4828
Practice Address - Street 1:5235 MISSION OAKS BLVD
Practice Address - Street 2:#570
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5400
Practice Address - Country:US
Practice Address - Phone:805-484-4828
Practice Address - Fax:805-484-4828
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11278439174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN