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General NPI Number Information
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NPI Number | 1619432390
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Entity Type | Organization
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Legal Business Name | THE MILK GROTTO, LLC
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 10619 PLUCHEA CV
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City | AUSTIN
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State | TX
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Zip | 78733-5721
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Country | US
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Telephone | 512-551-2371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 161621
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City | AUSTIN
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State | TX
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Zip | 78716-1621
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Country | US
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Telephone | 512-651-9360
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATINA WONG
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Credential | IBCLC
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Telephone | 703-244-9216
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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 |
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License Number State |
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