Healthcare Provider Details

I. General information

NPI: 1922403971
Provider Name (Legal Business Name): ALAINA SUZANNE ELDRIDGE IBCLC, NC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 MAYETTE AVE APT 28
SANTA ROSA CA
95405-7234
US

IV. Provider business mailing address

3725 MAYETTE AVE APT 28
SANTA ROSA CA
95405-7234
US

V. Phone/Fax

Practice location:
  • Phone: 707-599-2794
  • Fax:
Mailing address:
  • Phone: 707-599-2794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: