MEDICARE: VILLAGE LACTATION MEDICINE, LLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1285468959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE LACTATION MEDICINE, LLC

Provider Business Mailing Address
First Line	:	15960 PINE STRAND CT
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6365
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 10TH AVE N STE 501H
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-6615
Country	:	US
Telephone Number	:	561-760-1066
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, PHYSICIAN
Name	:	DR. LISANDRA PEREZ
Credential	:	MD
Telephone Number	:	561-760-1066

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	02/09/2026

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