Healthcare Provider Details

I. General information

NPI: 1215734595
Provider Name (Legal Business Name): ARBOR VITAE LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N HARBOR BLVD
ANAHEIM CA
92805-1809
US

IV. Provider business mailing address

800 N HARBOR BLVD
ANAHEIM CA
92805-1809
US

V. Phone/Fax

Practice location:
  • Phone: 949-405-0857
  • Fax:
Mailing address:
  • Phone: 949-405-0857
  • 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: TIFFANY WASHINGTON
Title or Position: OWNER
Credential: RN, BSN, IBCLC
Phone: 949-405-0857