Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 10964013 | NM |
NPI | 1023470283 |
---|---|
Provider Name | Aviva Levy Faust |
First Address | Santa Fe, NM 87501-1546 |
Second Address | Santa Fe, NM 87501-1546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 25/03/2016 |