Healthcare Provider Details

I. General information

NPI: 1801261599
Provider Name (Legal Business Name): MARINA LANGESFELD IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2015
Last Update Date: 12/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W PARK DR APT 10
MIAMI FL
33172-3978
US

IV. Provider business mailing address

425 W PARK DR APT 10
MIAMI FL
33172-3978
US

V. Phone/Fax

Practice location:
  • Phone: 305-218-8005
  • Fax:
Mailing address:
  • Phone: 305-218-8005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-58476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: