Healthcare Provider Details

I. General information

NPI: 1801489117
Provider Name (Legal Business Name): PAMELA PUENTE IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 S KYRENE RD STE 125&126
TEMPE AZ
85284-2100
US

IV. Provider business mailing address

8400 S KYRENE RD STE 126
TEMPE AZ
85284-2172
US

V. Phone/Fax

Practice location:
  • Phone: 480-442-8491
  • Fax:
Mailing address:
  • Phone: 480-442-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: