Healthcare Provider Details

I. General information

NPI: 1871051987
Provider Name (Legal Business Name): TANIA NUEZCA IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ROCKMEAD DR STE 212
KINGWOOD TX
77339-2100
US

IV. Provider business mailing address

15211 MORNING DOVE DR
HUMBLE TX
77396-2225
US

V. Phone/Fax

Practice location:
  • Phone: 281-305-0411
  • Fax:
Mailing address:
  • Phone: 832-265-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-317143
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: