Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-25505 | CA |
NPI | 1104472281 |
---|---|
Provider Name | Alexandra Lopez |
First Address | Watsonville, CA 95077-1870 |
Second Address | Watsonville, CA 95076-4809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 14/08/2019 |