Basic Information
| Provider Information | |||||||||
| NPI: | 1679841886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | LEANNA | ||||||||
| MiddleName: | MOORE | ||||||||
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| Credential: | IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N SAN ANTONIO RD | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101316 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 N R ST | ||||||||
| Address2: | PUBLIC HEALTH DEPARTMENT | ||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934365226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057376470 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2011 | ||||||||
| LastUpdateDate: | 12/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174N00000X | 11191131 | CA | Y | Other Service Providers | Lactation Consultant, Non-RN |
No ID Information.