Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-165231 | CA |
NPI | 1154990737 |
---|---|
Provider Name | Amanda Faye Dragos Carr |
First Address | Petaluma, CA 94954-4346 |
Second Address | Petaluma, CA 94954-4346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 18/06/2021 |