Healthcare Provider Details

I. General information

NPI: 1043001456
Provider Name (Legal Business Name): SOUTH TEXAS LATCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 COUNTY ROAD 453
EL CAMPO TX
77437-6778
US

IV. Provider business mailing address

2528 COUNTY ROAD 453
EL CAMPO TX
77437-6778
US

V. Phone/Fax

Practice location:
  • Phone: 979-217-1724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: BAILEY KRENEK
Title or Position: OWNER
Credential: IBCLC
Phone: 979-217-1724