Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1366061913 |
---|---|
Provider Name | Amelia Tavares |
First Address | Westlake Village, CA 91361-1647 |
Second Address | Montana City, MT 59634-9203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2020 |
Last Update Date | 14/04/2020 |