Individual
MRS. TARYN LEE PHANTHANUSORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
23315 VIA BAHIA, MISSION VIEJO, CA 92691-2115
(949) 677-7510
Mailing address
23315 VIA BAHIA, MISSION VIEJO, CA 92691-2115
(949) 677-7510
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
11242387
CA
Other
Enumeration date
01/26/2015
Last updated
01/26/2015
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