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General NPI Number Information
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NPI Number | 1790576957
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Entity Type | Organization
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Legal Business Name | MY MOM GLOW LLC
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 2750 N 29TH AVE STE 309
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City | HOLLYWOOD
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State | FL
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Zip | 33020-1521
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Country | US
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Telephone | 954-880-1182
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Fax | 954-301-8385
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Provider Business Mailing Address
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Address Line | 320 SW 67TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33023-1274
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Country | US
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Telephone | 305-600-8109
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA ANN LOBAINA
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Credential | LM,CPM,IBCLC
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Telephone | 305-600-8109
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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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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State |
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