Provider Demographics
NPI:1598545147
Name:STREETER, GRACIELA (CLC)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:STREETER
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8529 DE VOS DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2327
Mailing Address - Country:US
Mailing Address - Phone:619-784-4005
Mailing Address - Fax:
Practice Address - Street 1:8529 DE VOS DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2327
Practice Address - Country:US
Practice Address - Phone:619-784-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN