1275826299 NPI number — SHARON CASTANEDA WATKINS LVN,CLE,IBCLC,RLC

Table of content: SHARON CASTANEDA WATKINS LVN,CLE,IBCLC,RLC (NPI 1275826299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275826299 NPI number — SHARON CASTANEDA WATKINS LVN,CLE,IBCLC,RLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATKINS
Provider First Name:
SHARON
Provider Middle Name:
CASTANEDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LVN,CLE,IBCLC,RLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATKINS
Provider Other First Name:
SHARON
Provider Other Middle Name:
CASTANEDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
IBCLC,RLC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275826299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 GARDENSIDE DR
Provider Second Line Business Mailing Address:
#28
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94131-3313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-550-1877
Provider Business Mailing Address Fax Number:
415-550-2688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 GARDENSIDE DR
Provider Second Line Business Practice Location Address:
#28
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94131-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-550-1877
Provider Business Practice Location Address Fax Number:
415-550-2688
Provider Enumeration Date:
05/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174N00000X , with the licence number:  10948640 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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