=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609652304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASITO X PASITO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2023
-----------------------------------------------------
Last Update Date | 09/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 N RAYMOND AVE UNIT 3
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91103-3763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-665-0243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 N RAYMOND AVE UNIT 3
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91103-3763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-665-0243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | SABRINA ARIANA JIMENEZ
-----------------------------------------------------
Credential | CBD CPD CBC CPNE CBE
-----------------------------------------------------
Telephone | 626-665-0243
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------