Healthcare Provider Details

I. General information

NPI: 1811360753
Provider Name (Legal Business Name): CAROLINE DE VILLE DE GOYET IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2015
Last Update Date: 10/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14202 WOODVILLE GARDENS DR
HOUSTON TX
77077-1446
US

IV. Provider business mailing address

14202 WOODVILLE GARDENS DR
HOUSTON TX
77077-1446
US

V. Phone/Fax

Practice location:
  • Phone: 832-419-2256
  • Fax:
Mailing address:
  • Phone: 832-419-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-88564
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: