Healthcare Provider Details

I. General information

NPI: 1477386647
Provider Name (Legal Business Name): CLAIRE CERNIGLIA RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE SMITH RN

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 E DEL MAR BLVD APT 315
PASADENA CA
91106-3438
US

IV. Provider business mailing address

1127 E DEL MAR BLVD APT 315
PASADENA CA
91106-3438
US

V. Phone/Fax

Practice location:
  • Phone: 301-785-3352
  • Fax:
Mailing address:
  • Phone: 301-785-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN95390029
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1670572
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: