MEDICARE: WHOLISTIC LACTATION 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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1629907639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLISTIC LACTATION LLC

Provider Business Mailing Address
First Line	:	3355 COCHRAN ST
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-2510
Country	:	US
Telephone Number	:	661-347-8342
Fax Number	:	424-269-0626

Provider Business Practice Location Address
First Line	:	3355 COCHRAN ST
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-2510
Country	:	US
Telephone Number	:	661-347-8342
Fax Number	:	424-269-0626

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA PONGO
Credential	:
Telephone Number	:	805-231-6745

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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Directions to “WHOLISTIC LACTATION LLC ” Practice Location

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