Healthcare Provider Details

I. General information

NPI: 1417353848
Provider Name (Legal Business Name): CATHLEEN REDUS IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 07/10/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 MCCREADY AVE
LOS ANGELES CA
90039-3307
US

IV. Provider business mailing address

9433 SPRINGWATER DR
DALLAS TX
75228-4151
US

V. Phone/Fax

Practice location:
  • Phone: 310-956-0442
  • Fax:
Mailing address:
  • Phone: 310-956-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: