Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | IBCLC #L-57367 |
NPI | 1265837645 |
---|---|
Provider Name | Mrs. Tanya Powell |
First Address | San Rafael, CA 94903-1951 |
Second Address | San Rafael, CA 94903-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2014 |
Last Update Date | 28/10/2014 |