Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1184025629 |
---|---|
Provider Name | Angela Burger |
First Address | San Mateo, CA 94401-5104 |
Second Address | San Mateo, CA 94401-5104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2014 |
Last Update Date | 13/01/2017 |