Individual
KELLY RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
3533 MICHAEL DR, SAN MATEO, CA 94403-4208
(650) 867-6752
Mailing address
3533 MICHAEL DR, SAN MATEO, CA 94403-4208
(650) 867-6752
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
L-110775
CA
Other
Enumeration date
09/27/2018
Last updated
09/27/2018
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