Provider Demographics
NPI:1902659394
Name:BLAZEVIC, DANIJELA (IBCLC)
Entity type:Individual
Prefix:
First Name:DANIJELA
Middle Name:
Last Name:BLAZEVIC
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 1:962 MORELLO AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4738
Mailing Address - Country:US
Mailing Address - Phone:925-262-6651
Mailing Address - Fax:
Practice Address - Street 1:962 MORELLO AVE
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4738
Practice Address - Country:US
Practice Address - Phone:925-262-6651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313050174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN