Provider Demographics
NPI:1982319265
Name:LACTATION LLC
Entity type:Organization
Organization Name:LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS,IBCLC
Authorized Official - Phone:239-851-0909
Mailing Address - Street 1:4539 SW 15TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6314
Mailing Address - Country:US
Mailing Address - Phone:239-851-0909
Mailing Address - Fax:866-229-4468
Practice Address - Street 1:4539 SW 15TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6314
Practice Address - Country:US
Practice Address - Phone:239-851-0909
Practice Address - Fax:866-229-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82-5482653OtherLACTATION