Healthcare Provider Details

I. General information

NPI: 1912713272
Provider Name (Legal Business Name): CANDACE K ROBBEN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E SOUTHERN AVE STE 3A
MESA AZ
85204-5247
US

IV. Provider business mailing address

201 S GREENFIELD RD LOT 281
MESA AZ
85206-1251
US

V. Phone/Fax

Practice location:
  • Phone: 480-242-5588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-316524
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: