Individual
LACIE VIDOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
15770 MISS ELLIE LN, LAKESIDE, CA 92040-2600
(619) 592-6680
Mailing address
15770 MISS ELLIE LN, LAKESIDE, CA 92040-2600
(619) 592-6680
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
806895
CA
Other
Enumeration date
01/17/2022
Last updated
01/17/2022
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