Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-109794 | CA |
NPI | 1376065946 |
---|---|
Provider Name | Mrs. Rebecca Shelly Agi |
First Address | Beverly Hills, CA 90212 |
Second Address | Beverly Hills, CA 90212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2017 |
Last Update Date | 11/03/2020 |