Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-153111 | CA |
NPI | 1225659840 |
---|---|
Provider Name | Antonina Proshak |
First Address | West Sacramento, CA 95691-6205 |
Second Address | Sacramento, CA 95838-3466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2020 |
Last Update Date | 05/05/2020 |