Provider Demographics
NPI:1700302486
Name:BRAYTON, JAIMEE MICHELE (IBCLC)
Entity Type:Individual
Prefix:
First Name:JAIMEE
Middle Name:MICHELE
Last Name:BRAYTON
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:PO BOX 15545
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-5545
Mailing Address - Country:US
Mailing Address - Phone:949-610-9125
Mailing Address - Fax:
Practice Address - Street 1:1811 CLIFF DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5210
Practice Address - Country:US
Practice Address - Phone:310-622-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-124466174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN