Healthcare Provider Details

I. General information

NPI: 1457590564
Provider Name (Legal Business Name): FAITH BALDWIN PLOUDE BA, RLC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21780 SW 157 AVENUE
MIAMI-DADE FL
33170-2112
US

IV. Provider business mailing address

21780 SW 157 AVENUE
MIAMI-DADE FL
33170-2112
US

V. Phone/Fax

Practice location:
  • Phone: 305-282-1975
  • Fax: 305-248-8235
Mailing address:
  • Phone: 305-282-1975
  • Fax: 305-248-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: