Healthcare Provider Details

I. General information

NPI: 1083161772
Provider Name (Legal Business Name): NINA CARBONE-PELLERIN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA CARBONE IBCLC

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 MLK JR WAY
BERKELEY CA
94704-3238
US

IV. Provider business mailing address

2634 MLK JR WAY
BERKELEY CA
94704-3238
US

V. Phone/Fax

Practice location:
  • Phone: 510-331-6462
  • Fax:
Mailing address:
  • Phone: 510-331-6462
  • 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: