MEDICARE: REBECCA LAVAE DIEL BS, 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)	11076584	CA

General Provider Information

NPI Number	:	1285935601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LAVAE DIEL BS, IBCLC

Provider Business Mailing Address
First Line	:	3490 TWIN OAKS CT
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-5226
Country	:	US
Telephone Number	:	707-266-1747
Fax Number	:

Provider Business Practice Location Address
First Line	:	3490 TWIN OAKS CT
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-5226
Country	:	US
Telephone Number	:	707-266-1747
Fax Number	:

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

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	09/05/2013

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