Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 10218424 | CA |
NPI | 1336545771 |
---|---|
Provider Name | Mary Marine |
First Address | Martinez, CA 94553-4634 |
Second Address | Martinez, CA 94553-2681 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2014 |
Last Update Date | 12/11/2014 |