Provider Demographics
NPI:1225863566
Name:RODRIGUEZ, ANDREA (IBCLC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11162 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2960
Mailing Address - Country:US
Mailing Address - Phone:310-345-2006
Mailing Address - Fax:
Practice Address - Street 1:906 E 105TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3433
Practice Address - Country:US
Practice Address - Phone:310-345-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-157492174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty