Provider Demographics
NPI:1306622147
Name:BOYD, LISA MARIE (IBCLC-CERTIFICATE)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:BOYD
Suffix:
Gender:F
Credentials:IBCLC-CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 1/2 MORRO AVENUE
Mailing Address - Street 2:UPPR
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442
Mailing Address - Country:US
Mailing Address - Phone:805-235-5790
Mailing Address - Fax:
Practice Address - Street 1:1220 1/2 MORRO AVENUE
Practice Address - Street 2:UPPR
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442
Practice Address - Country:US
Practice Address - Phone:805-235-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-135986174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN