Provider Demographics
NPI:1154791184
Name:REIS, PATTY (IBCLC, ICEA-CCE,CPE)
Entity type:Individual
Prefix:MS
First Name:PATTY
Middle Name:
Last Name:REIS
Suffix:
Gender:F
Credentials:IBCLC, ICEA-CCE,CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 ATRIUM CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8503
Mailing Address - Country:US
Mailing Address - Phone:661-203-4817
Mailing Address - Fax:
Practice Address - Street 1:13401 ATRIUM CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-8503
Practice Address - Country:US
Practice Address - Phone:661-203-4817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11170249174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN