Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11210477 | NY |
NPI | 1316466618 |
---|---|
Provider Name | Patricia Maria Gonzaga De Lima |
First Address | Rego Park, NY 11374-1479 |
Second Address | Rego Park, NY 11374-1479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2017 |
Last Update Date | 18/09/2017 |