Healthcare Provider Details

I. General information

NPI: 1902044639
Provider Name (Legal Business Name): MILKALICIOUS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27791 LA PAZ RD
LAGUNA NIGUEL CA
92677-3919
US

IV. Provider business mailing address

27791 LA PAZ RD
LAGUNA NIGUEL CA
92677-3919
US

V. Phone/Fax

Practice location:
  • Phone: 949-831-6455
  • Fax:
Mailing address:
  • Phone: 949-831-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. JENNIFER ANNE RITCHIE
Title or Position: PRESIDENT
Credential: IBCLC
Phone: 949-831-6455