Healthcare Provider Details

I. General information

NPI: 1184918773
Provider Name (Legal Business Name): MARIBETH CIALLI SMITH B.S., IBCLC, RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ST JOSEPH PKWY #324
HOUSTON TX
77002-8598
US

IV. Provider business mailing address

300 ST. JOSEPH PARKWAY #324
HOUSTON TX
77002-8701
US

V. Phone/Fax

Practice location:
  • Phone: 713-302-1591
  • Fax: 281-888-3166
Mailing address:
  • Phone: 713-302-1591
  • Fax: 281-888-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number198-15181
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: