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General NPI Number Information
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NPI Number | 1225513112
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Entity Type | Individual
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Provider Name | YASMIN DERA BASKIN IBCLC
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Gender | Female
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 531 N ROSSMORE AVE APT 201
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City | LOS ANGELES
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State | CA
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Zip | 90004-2434
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Country | US
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Telephone | 424-645-1913
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Fax |
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Provider Business Mailing Address
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Address Line | 21350 AVALON BLVD # 4934
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City | CARSON
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State | CA
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Zip | 90745-2260
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-142982
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License Number State | CA
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