Diana Stephanie Clark, IBCLC

Primary specialty

Lactation Consultant (Non-RN)Taxonomy code 174N00000X

License

11137880 Issued in CA

Practice address

28 Mountain Laurel Way
Azusa, CA 91702-6264

Phone

(626) 222-4614

NPI assigned

Nov 11, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diana Stephanie Orellana Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1003630666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 MOUNTAIN LAUREL WAY",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917026264",
            "telephone_number": "626-222-4614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 MOUNTAIN LAUREL WAY",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917026264",
            "telephone_number": "626-222-4614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1621 W Carroll Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606122501",
            "country_code": "US",
            "telephone_number": "888-510-0059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DIANA",
        "middle_name": "STEPHANIE",
        "credential": "IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-11",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "CA",
            "license": "11137880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE LACTATION NETWORK",
            "identifier": "1144749391",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "ORELLANA",
            "middle_name": "STEPHANIE",
            "credential": "IBCLC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel Cheng
• Dream Mong-Ting Chew, OTR/L
• Chris Altunis, DDS, Inc
• Cressina Chung, NP
• Guadalupe Elizabeth Cisar
• Mark Cole, PA
• Consumerhealth, Inc.
• Consumerhealth, Inc.
• Justin M Contreras
• Rosaura Contreras, RD

• Lactation Consultant (Non-RN) in Azusa, CA
• Providers in Azusa, CA by specialty
• Lactation Consultant (Non-RN) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.