Provider Demographics
NPI:1285935601
Name:DIEL, REBECCA LAVAE (BS, IBCLC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LAVAE
Last Name:DIEL
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:DIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, IBCLC
Mailing Address - Street 1:3490 TWIN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-5226
Mailing Address - Country:US
Mailing Address - Phone:707-266-1747
Mailing Address - Fax:
Practice Address - Street 1:3490 TWIN OAKS CT
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-5226
Practice Address - Country:US
Practice Address - Phone:707-266-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11076584174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN