Healthcare Provider Details

I. General information

NPI: 1447891882
Provider Name (Legal Business Name): KRISTIN MCCORD RD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26565 AGOURA RD STE 200
CALABASAS CA
91302-1990
US

IV. Provider business mailing address

403 S 1ST ST
TIPP CITY OH
45371-1709
US

V. Phone/Fax

Practice location:
  • Phone: 800-998-7042
  • Fax:
Mailing address:
  • Phone: 937-657-3459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number7552
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-313074
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: