Provider Demographics
NPI:1023888385
Name:MALTESE, KAYLA ERIN (IBCLC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ERIN
Last Name:MALTESE
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 1:2335 SHAMROCK ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-4569
Mailing Address - Country:US
Mailing Address - Phone:619-707-4577
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-312995174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN