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General NPI Number Information
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NPI Number | 1043180854
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Entity Type | Organization
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Legal Business Name | LAKE LACTATION LLC
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 1464 WESTWOOD AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3702
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Country | US
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Telephone | 440-201-9411
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Fax |
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Provider Business Mailing Address
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Address Line | 1464 WESTWOOD AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3702
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Country | US
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Telephone | 440-201-9411
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Fax |
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Authorized Official
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Title or Position | OWNER/LACTATION CONSULTANT
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Name | MRS. TANA GARGALIANOS
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Credential | BSN, RN, IBCLC
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Telephone | 440-315-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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