Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-19108 | CA |
NPI | 1154774438 |
---|---|
Provider Name | Janet Acosta |
First Address | Covina, CA 91722-2347 |
Second Address | Covina, CA 91722-2347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2016 |
Last Update Date | 21/07/2016 |