Healthcare Provider Details

I. General information

NPI: 1194933424
Provider Name (Legal Business Name): MARGIE SUE DEUTSCH LASH MSED, IBCLC, LLLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PINTAIL
IRVINE CA
92604-3633
US

IV. Provider business mailing address

13 PINTAIL
IRVINE CA
92604-3633
US

V. Phone/Fax

Practice location:
  • Phone: 949-786-0065
  • Fax:
Mailing address:
  • Phone: 949-786-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number189-10409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: