Provider Demographics
NPI:1386080273
Name:LAVY, TINA M (IBCLC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:LAVY
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 1:1447 VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-5194
Mailing Address - Country:US
Mailing Address - Phone:530-751-3871
Mailing Address - Fax:
Practice Address - Street 1:1447 VALLEY CT
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-5194
Practice Address - Country:US
Practice Address - Phone:530-751-3871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education