Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-56588 | CA |
NPI | 1023413978 |
---|---|
Provider Name | Maria Moreno |
First Address | Reseda, CA 91335-5323 |
Second Address | Mission Hills, CA 91345-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 04/11/2014 |