Provider Demographics
NPI:1205466935
Name:GELLIS, VICTORIA (IBCLC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GELLIS
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 1:3358 31ST ST APT 1/2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4620
Mailing Address - Country:US
Mailing Address - Phone:914-462-9589
Mailing Address - Fax:
Practice Address - Street 1:8325 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9322
Practice Address - Country:US
Practice Address - Phone:619-724-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-164785174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN