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General NPI Number Information
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NPI Number | 1619685583
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Entity Type | Organization
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Legal Business Name | IMMA LACTATION, LLC
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 537 N LAS PALMAS AVE
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City | LOS ANGELES
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State | CA
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Zip | 90004-1017
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Country | US
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Telephone | 323-364-4397
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Fax |
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Provider Business Mailing Address
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Address Line | 537 N LAS PALMAS AVE
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City | LOS ANGELES
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State | CA
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Zip | 90004-1017
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Country | US
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Telephone | 323-364-4397
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Fax |
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Authorized Official
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Title or Position | OWNER/IBCLC
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Name | SARAH SIEBOLD
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Credential | IBCLC
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Telephone | 323-364-4397
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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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