=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790467181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LACTATION CONSULTANTS OF AMERICA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2023
-----------------------------------------------------
Last Update Date | 08/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13579 SW FEIRING LN
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-217-3660
-----------------------------------------------------
Fax | 833-563-2266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6236 COLGATE AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90036-3144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-223-4208
-----------------------------------------------------
Fax | 833-563-2266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SARAH GRUMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-223-4208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WL0100X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Registered Nurse)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------