Provider Demographics
NPI:1306679089
Name:FISCHER, GENTRY ELISABETH (IBCLC)
Entity type:Individual
Prefix:
First Name:GENTRY
Middle Name:ELISABETH
Last Name:FISCHER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:1780 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3562
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1780 OAKDALE ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3562
Practice Address - Country:US
Practice Address - Phone:617-833-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-305576174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN