Healthcare Provider Details

I. General information

NPI: 1982365649
Provider Name (Legal Business Name): MALGORZATA RAJTAR-SULLIVAN LM, CPM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 COCHRAN ST STE 205
SIMI VALLEY CA
93063-2500
US

IV. Provider business mailing address

3355 COCHRAN ST STE 205
SIMI VALLEY CA
93063-2500
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM724
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-305466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: