Healthcare Provider Details

I. General information

NPI: 1609417476
Provider Name (Legal Business Name): MARY POMEROY SEE IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30520 ROLLINGOAK DR
TEHACHAPI CA
93561-8518
US

IV. Provider business mailing address

30520 ROLLINGOAK DR
TEHACHAPI CA
93561-8518
US

V. Phone/Fax

Practice location:
  • Phone: 310-883-4131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-108670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: