Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-28731 | CA |
NPI | 1093345423 |
---|---|
Provider Name | Mary Clare Ovalle |
First Address | Fresno, CA 93730-4772 |
Second Address | Fresno, CA 93730-4772 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2020 |
Last Update Date | 24/01/2020 |