Provider Demographics
NPI:1366728719
Name:WARREN, MARIELLE (IBCLC)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:WARREN
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 1:285 MONROE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-1015
Mailing Address - Country:US
Mailing Address - Phone:650-200-3972
Mailing Address - Fax:
Practice Address - Street 1:285 MONROE DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1015
Practice Address - Country:US
Practice Address - Phone:650-200-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11194444174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN