Healthcare Provider Details

I. General information

NPI: 1740057199
Provider Name (Legal Business Name): SAM DEL TORO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 CHAMPIONS BLVD STE 2
AUBURN AL
36830-6471
US

IV. Provider business mailing address

1544 TALHIEM ST
AUBURN AL
36832-6512
US

V. Phone/Fax

Practice location:
  • Phone: 334-745-6447
  • Fax:
Mailing address:
  • Phone: 205-542-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAMANTHA CLAIR DEL TORO
Title or Position: RN, IBCLC
Credential: RN, IBCLC
Phone: 205-542-4301