Provider Demographics
NPI:1144047135
Name:ORELLANA, JOSIE (IBCLC)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:O
Other - Last Name:ORELLANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:28 MOUNTAIN LAUREL WAY
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-6264
Mailing Address - Country:US
Mailing Address - Phone:626-648-0964
Mailing Address - Fax:
Practice Address - Street 1:28 MOUNTAIN LAUREL WAY
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-6264
Practice Address - Country:US
Practice Address - Phone:626-648-0964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
CA10218568174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN