Provider Demographics
NPI:1720817380
Name:GEISLER-JUAREZ, MOLLY ROSE (LM, CPM, IBCLC, MAS)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ROSE
Last Name:GEISLER-JUAREZ
Suffix:
Gender:F
Credentials:LM, CPM, IBCLC, MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 45TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3413
Mailing Address - Country:US
Mailing Address - Phone:781-718-7916
Mailing Address - Fax:
Practice Address - Street 1:971 45TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-3413
Practice Address - Country:US
Practice Address - Phone:781-718-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-315239174N00000X
CALM644176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN