Provider Demographics
NPI:1124531231
Name:SCALZO, LAURA FRANCES (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:FRANCES
Last Name:SCALZO
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 LEANING OAK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6146
Mailing Address - Country:US
Mailing Address - Phone:925-234-3837
Mailing Address - Fax:
Practice Address - Street 1:1360 LEANING OAK DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-6146
Practice Address - Country:US
Practice Address - Phone:925-234-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL-27615OtherINTERNATIONAL BOARD OF CERTIFIED LACTATION CONSULTANTS
CA271592OtherBOARD OF REGISTERED NURSING