Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-13187 | CA |
NPI | 1356899371 |
---|---|
Provider Name | Vicky Adeva |
First Address | Long Beach, CA 90805-4304 |
Second Address | Long Beach, CA 90813-3296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2016 |
Last Update Date | 19/09/2016 |