Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-60388 | CA |
NPI | 1043601032 |
---|---|
Provider Name | Miss Rebecca Pancake |
First Address | Thousand Oaks, CA 91362-5301 |
Second Address | Thousand Oaks, CA 91362-5301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2015 |
Last Update Date | 11/02/2015 |