MEDICARE: MRS. MELLISSA ALVARADO IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-47392	TX

General Provider Information

NPI Number	:	1124443148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELLISSA ALVARADO IBCLC

Provider Business Mailing Address
First Line	:	1624 CORIANDER DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78741-7520
Country	:	US
Telephone Number	:	512-803-5881
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 CORIANDER DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78741-7520
Country	:	US
Telephone Number	:	512-803-5881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	02/27/2014

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