MEDICARE: ANA ROSA SALDIVAR LARA 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-307059	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15833189	OTHER		CAQH

General Provider Information

NPI Number	:	1790499986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA ROSA SALDIVAR LARA IBCLC

Provider Business Mailing Address
First Line	:	4938 N MONTE CRISTO WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-5808
Country	:	US
Telephone Number	:	702-232-0644
Fax Number	:

Provider Business Practice Location Address
First Line	:	4938 N MONTE CRISTO WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-5808
Country	:	US
Telephone Number	:	702-232-0644
Fax Number	:

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

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	01/11/2023

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