Healthcare Provider Details

I. General information

NPI: 1114452448
Provider Name (Legal Business Name): ANGELICA BENITEZ IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MS76
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

2105 BEVERLY BLVD 117
LOS ANGELES CA
90057-2216
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-2113
  • Fax:
Mailing address:
  • Phone: 213-413-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-13468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: