Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-31537 | CA |
NPI | 1073134219 |
---|---|
Provider Name | Mina Ognjanovic-Jasovic |
First Address | Encino, CA 91316-1830 |
Second Address | Encino, CA 91316-1830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2020 |
Last Update Date | 28/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0002894751-0001-8 | CITY OF LOS ANGELES (01) | CA |
L-31537 | IBCLC (01) |