Provider Demographics
NPI:1588121784
Name:HUNZIKER, KELLIE JEAN (MPH, RD, IBCLC)
Entity type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:JEAN
Last Name:HUNZIKER
Suffix:
Gender:F
Credentials:MPH, RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 N IVY ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2722
Mailing Address - Country:US
Mailing Address - Phone:760-580-1907
Mailing Address - Fax:
Practice Address - Street 1:1443 N IVY ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-2722
Practice Address - Country:US
Practice Address - Phone:760-580-1907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-83381174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN