Healthcare Provider Details

I. General information

NPI: 1528702370
Provider Name (Legal Business Name): ANA YANET OLIVARES TAPIA DE SAIZ IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YANET OLIVARES IBCLC

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S MONTGOMERY ST APT 326
PORTLAND OR
97201-5145
US

IV. Provider business mailing address

320 S MONTGOMERY ST APT 326
PORTLAND OR
97201-5145
US

V. Phone/Fax

Practice location:
  • Phone: 971-386-3865
  • Fax:
Mailing address:
  • Phone: 971-386-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-30198
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: