Healthcare Provider Details

I. General information

NPI: 1558143834
Provider Name (Legal Business Name): BROOKE AMY KAJDAS RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 CANEHILL AVE
LONG BEACH CA
90808-2926
US

IV. Provider business mailing address

3440 CANEHILL AVE
LONG BEACH CA
90808-2926
US

V. Phone/Fax

Practice location:
  • Phone: 562-972-7282
  • Fax:
Mailing address:
  • Phone: 562-972-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-311370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: