Healthcare Provider Details

I. General information

NPI: 1528816998
Provider Name (Legal Business Name): MILK DIVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 AUSTIN CENTER BLVD STE 225
AUSTIN TX
78731-3293
US

IV. Provider business mailing address

6850 AUSTIN CENTER BLVD STE 225
AUSTIN TX
78731-3293
US

V. Phone/Fax

Practice location:
  • Phone: 512-846-6455
  • Fax:
Mailing address:
  • Phone: 512-846-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: NAIOMI CATRON
Title or Position: CEO, FOUNDER & LACTATION CONSULTANT
Credential:
Phone: 512-804-6717