Provider Demographics
NPI:1689266611
Name:MORADIAN, AILEEN (RN, MSN-ED, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:AILEEN
Middle Name:
Last Name:MORADIAN
Suffix:
Gender:F
Credentials:RN, MSN-ED, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 RANGER AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1527
Mailing Address - Country:US
Mailing Address - Phone:909-703-3079
Mailing Address - Fax:
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-703-3079
Practice Address - Fax:909-703-3582
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-106665163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty