Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1184268435 |
---|---|
Provider Name | Ms. Lisa Mathews |
First Address | Roseville, CA 95747-9529 |
Second Address | Sacramento, CA 95838-3466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2019 |
Last Update Date | 30/10/2019 |