Provider Demographics
NPI:1982365649
Name:RAJTAR-SULLIVAN, MALGORZATA (LM, CPM, IBCLC)
Entity type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:
Last Name:RAJTAR-SULLIVAN
Suffix:
Gender:F
Credentials:LM, CPM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 COCHRAN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2500
Mailing Address - Country:US
Mailing Address - Phone:661-347-8342
Mailing Address - Fax:
Practice Address - Street 1:3355 COCHRAN ST STE 205
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2500
Practice Address - Country:US
Practice Address - Phone:661-347-8342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-305466174N00000X
CALM724176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL-305466OtherIBCLC
CALM724OtherMEDICAL BOARD OF CALIFORNIA