=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366319790
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEMENTINA HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2025
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 DEVELIN DR
-----------------------------------------------------
City | PHOENIXVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19460-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-554-9597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 DEVELIN DR
-----------------------------------------------------
City | PHOENIXVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19460-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-554-9597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER AND CEO
-----------------------------------------------------
Name | MARAIZA THIAGO-MUNOZ
-----------------------------------------------------
Credential | IBCLC
-----------------------------------------------------
Telephone | 610-554-9597
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WL0100X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Registered Nurse)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------