Provider Demographics
NPI:1285468959
Name:VILLAGE LACTATION MEDICINE, LLC
Entity type:Organization
Organization Name:VILLAGE LACTATION MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-760-1066
Mailing Address - Street 1:15960 PINE STRAND CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6365
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15960 PINE STRAND CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6365
Practice Address - Country:US
Practice Address - Phone:561-760-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care