Provider Demographics
NPI:1205475852
Name:JACOBS, MICHELLE ERIN (IBCLC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ERIN
Last Name:JACOBS
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 1:2479 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1448
Mailing Address - Country:US
Mailing Address - Phone:608-335-7960
Mailing Address - Fax:
Practice Address - Street 1:22 ODYSSEY STE 255
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7701
Practice Address - Country:US
Practice Address - Phone:608-335-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty