Healthcare Provider Details

I. General information

NPI: 1972897536
Provider Name (Legal Business Name): EAST BAY BREASTFEEDING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 SAN PABLO AVE STE 110
ALBANY CA
94706-1567
US

IV. Provider business mailing address

828 SAN PABLO AVE STE 110
ALBANY CA
94706-1567
US

V. Phone/Fax

Practice location:
  • Phone: 510-847-2364
  • Fax:
Mailing address:
  • Phone: 510-847-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number108-46737
License Number State

VIII. Authorized Official

Name: MS. MOLLY BRANNIGAN
Title or Position: LACTATION CONSULTANT
Credential: IBCLC
Phone: 510-847-2364