Provider Demographics
NPI:1386137941
Name:BOSQUE BIRTH & BREASTFEEDING LLC
Entity type:Organization
Organization Name:BOSQUE BIRTH & BREASTFEEDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:505-221-6397
Mailing Address - Street 1:1305 BLAKE RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4779
Mailing Address - Country:US
Mailing Address - Phone:505-221-6397
Mailing Address - Fax:505-503-8097
Practice Address - Street 1:1305 BLAKE RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4779
Practice Address - Country:US
Practice Address - Phone:505-221-6397
Practice Address - Fax:505-503-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-55665174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-55665OtherIBLCE