Healthcare Provider Details

I. General information

NPI: 1376354977
Provider Name (Legal Business Name): SANDRA ESCAMILLA IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 RAMBLE LN STE 115
AUSTIN TX
78745-2281
US

IV. Provider business mailing address

169 CASCATA WAY
LIBERTY HILL TX
78642-2125
US

V. Phone/Fax

Practice location:
  • Phone: 512-808-0237
  • Fax:
Mailing address:
  • Phone: 811-475-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-19885
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: