Provider Demographics
NPI:1114519220
Name:LILIENTHAL, BETH (CLEC, PCD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LILIENTHAL
Suffix:
Gender:F
Credentials:CLEC, PCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5110
Mailing Address - Country:US
Mailing Address - Phone:831-588-7367
Mailing Address - Fax:
Practice Address - Street 1:521 35TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-5110
Practice Address - Country:US
Practice Address - Phone:831-588-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN