Healthcare Provider Details

I. General information

NPI: 1477763589
Provider Name (Legal Business Name): LACTATION INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 N GREENCRAIG RD
LOS ANGELES CA
90049-2842
US

IV. Provider business mailing address

3441 CLAIRTON PL
ENCINO CA
91436-4137
US

V. Phone/Fax

Practice location:
  • Phone: 310-476-1404
  • Fax: 310-476-1404
Mailing address:
  • Phone: 818-995-7442
  • Fax: 818-995-0634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELLEN P SHELL
Title or Position: DIRECTOR
Credential: IBCLC
Phone: 818-995-7442