Healthcare Provider Details

I. General information

NPI: 1982014023
Provider Name (Legal Business Name): MAREN MCCABE RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 ALAMEDA DE LAS PULGAS # 418
BELMONT CA
94002-3507
US

IV. Provider business mailing address

1025 ALAMEDA DE LAS PULGAS # 418
BELMONT CA
94002-3507
US

V. Phone/Fax

Practice location:
  • Phone: 415-792-9508
  • Fax:
Mailing address:
  • Phone: 415-792-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number729539
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-67576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: