Provider Demographics
NPI:1801433073
Name:ACOSTA, KAILI CATHERINE (RDN, IBCLC)
Entity type:Individual
Prefix:
First Name:KAILI
Middle Name:CATHERINE
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:RDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26803 FRISCO WAY
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-0345
Mailing Address - Country:US
Mailing Address - Phone:559-213-2462
Mailing Address - Fax:
Practice Address - Street 1:26803 FRISCO WAY
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-0345
Practice Address - Country:US
Practice Address - Phone:559-213-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-130014174N00000X
CA86032236133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty