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NPI Code Detail

MEDICARE: MS. TINA BENITEZ IBCLC, RLC

MEDICARE: MS. TINA BENITEZ IBCLC, RLC
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
1174N00000XLactation Consultant (Non-RN)

General Provider Information

NPI Number : 1588004808
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TINA BENITEZ IBCLC, RLC
Provider Business Mailing Address
First Line : 3917 ARCHMONT PL
Second Line :
City : OAKLAND
State : CA
Zip : 94605-2228
Country : US
Telephone Number : 510-206-7080
Fax Number :
Provider Business Practice Location Address
First Line : 3917 ARCHMONT PL
Second Line :
City : OAKLAND
State : CA
Zip : 94605-2228
Country : US
Telephone Number : 510-206-7080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2013
Last Update Date : 07/01/2013

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