Healthcare Provider Details

I. General information

NPI: 1285468959
Provider Name (Legal Business Name): VILLAGE LACTATION MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 10TH AVE N STE 501H
LAKE WORTH FL
33461-6615
US

IV. Provider business mailing address

15960 PINE STRAND CT
WELLINGTON FL
33414-6365
US

V. Phone/Fax

Practice location:
  • Phone: 561-760-1066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LISANDRA PEREZ
Title or Position: FOUNDER, PHYSICIAN
Credential: MD
Phone: 561-760-1066