Individual
ANISSA NISHIRA CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM, CPM, IBCLC
Contact information
Practice address
4545 FANUEL ST, SAN DIEGO, CA 92109-2904
(858) 900-2004
Mailing address
8550 GOLD COAST DR, SAN DIEGO, CA 92126-3606
(858) 361-6392
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
L-314425
—
176B00000X
Midwife
Primary
765
CA
Other
Enumeration date
10/11/2012
Last updated
05/06/2025
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