MEDICARE: SARAH ELIZABETH ORTEGA IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-14274

General Provider Information

NPI Number	:	1144854787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH ORTEGA IBCLC

Provider Business Mailing Address
First Line	:	4920 SPRING DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-6406
Country	:	US
Telephone Number	:	775-742-1299
Fax Number	:

Provider Business Practice Location Address
First Line	:	4920 SPRING DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-6406
Country	:	US
Telephone Number	:	775-742-1299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2020
Last Update Date	:	02/22/2020

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