Provider Demographics
NPI:1598504870
Name:MACMASTER, FAYETTE SOCORRO (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:FAYETTE
Middle Name:SOCORRO
Last Name:MACMASTER
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 1:2778 HAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5570
Mailing Address - Country:US
Mailing Address - Phone:559-269-2661
Mailing Address - Fax:
Practice Address - Street 1:2778 HAMPTON WAY
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-5570
Practice Address - Country:US
Practice Address - Phone:559-269-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL302822174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN