Provider Demographics
NPI:1386455772
Name:LEIJA, PHYLLIS (IBCLC)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:LEIJA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:G
Other - Last Name:LEIJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:3517 BRODY WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3586
Mailing Address - Country:US
Mailing Address - Phone:760-626-4121
Mailing Address - Fax:
Practice Address - Street 1:8200 S QUEBEC ST # A3123
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4411
Practice Address - Country:US
Practice Address - Phone:619-327-9354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-308030174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty