Provider Demographics
NPI:1881365807
Name:CHATTERJEE, JADAH PARKS (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JADAH
Middle Name:PARKS
Last Name:CHATTERJEE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29584 CABALLERO CT
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-4212
Mailing Address - Country:US
Mailing Address - Phone:323-823-4398
Mailing Address - Fax:
Practice Address - Street 1:29584 CABALLERO CT
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-4212
Practice Address - Country:US
Practice Address - Phone:323-823-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA804201163WL0100X
CA155632163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant