Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1053934646 |
---|---|
Provider Name | Latasha Marston |
First Address | Red Bluff, CA 96080-7604 |
Second Address | Red Bluff, CA 96080-7604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2020 |
Last Update Date | 18/05/2020 |