Provider Demographics
NPI:1104132893
Name:REYNOLDS, PEGGY ANN (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:REYNOLDS
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 1:2210 ENCINITAS BLVD
Mailing Address - Street 2:SUITE T
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4358
Mailing Address - Country:US
Mailing Address - Phone:760-809-7081
Mailing Address - Fax:
Practice Address - Street 1:2210 ENCINITAS BLVD
Practice Address - Street 2:SUITE T
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4358
Practice Address - Country:US
Practice Address - Phone:760-809-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-26246174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN