Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1114519220 |
---|---|
Provider Name | Mary Elizabeth Lilienthal |
First Address | Ben Lomond, CA 95005-9334 |
Second Address | Ben Lomond, CA 95005-9334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2021 |
Last Update Date | 09/02/2021 |