Healthcare Provider Details

I. General information

NPI: 1629907639
Provider Name (Legal Business Name): WHOLISTIC LACTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 COCHRAN ST
SIMI VALLEY CA
93063-2510
US

IV. Provider business mailing address

3355 COCHRAN ST
SIMI VALLEY CA
93063-2510
US

V. Phone/Fax

Practice location:
  • Phone: 661-347-8342
  • Fax: 424-269-0626
Mailing address:
  • Phone: 661-347-8342
  • Fax: 424-269-0626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREA PONGO
Title or Position: OWNER
Credential:
Phone: 805-231-6745