Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11082772 | CA |
NPI | 1093068025 |
---|---|
Provider Name | Teresita Munguia Tolentino |
First Address | San Jose, CA 95127-1952 |
Second Address | San Jose, CA 95127-1952 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2012 |
Last Update Date | 22/10/2012 |