Healthcare Provider Details

I. General information

NPI: 1972414910
Provider Name (Legal Business Name): MARIAH LIPMAN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 BRENT AVE
SOUTH PASADENA CA
91030-2707
US

IV. Provider business mailing address

825 BRENT AVE
SOUTH PASADENA CA
91030-2707
US

V. Phone/Fax

Practice location:
  • Phone: 626-390-0055
  • Fax:
Mailing address:
  • Phone: 626-390-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-322271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: