Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-132871 | CA |
Y | 176B00000X | Midwife | 471 | CA |
NPI | 1194099556 |
---|---|
Provider Name | Rachel Maxim |
First Address | Roseville, CA 95678-5100 |
Second Address | Roseville, CA 95678-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2012 |
Last Update Date | 31/12/2019 |