Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-25465 | CA |
NPI | 1194156695 |
---|---|
Provider Name | Mrs. Judy Long |
First Address | Sunnyvale, CA 94086-6386 |
Second Address | Sunnyvale, CA 94086-6386 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2013 |
Last Update Date | 09/12/2013 |