Provider Demographics
NPI:1285367763
Name:POYO-NIETO, CHELSEA K (IBCLC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:K
Last Name:POYO-NIETO
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 1:816 WALNUT ST APT B
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-0316
Mailing Address - Country:US
Mailing Address - Phone:310-985-0246
Mailing Address - Fax:
Practice Address - Street 1:816 WALNUT ST APT B
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-0316
Practice Address - Country:US
Practice Address - Phone:310-985-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-57978OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS