Provider Demographics
NPI:1235021585
Name:BORN TO BLOSSOM, LLC
Entity type:Organization
Organization Name:BORN TO BLOSSOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLAK
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:619-820-3238
Mailing Address - Street 1:9927 EUBANK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6502
Mailing Address - Country:US
Mailing Address - Phone:619-820-3238
Mailing Address - Fax:619-931-2786
Practice Address - Street 1:2831 CAMINO DEL RIO S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3802
Practice Address - Country:US
Practice Address - Phone:619-820-3238
Practice Address - Fax:619-931-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty