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NPI Code Detail

MEDICARE: ANGELA GOMES DOS SANTOS IBCLC

MEDICARE: ANGELA GOMES DOS SANTOS 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
1174N00000XLactation Consultant (Non-RN)L-162040

General Provider Information

NPI Number : 1710518527
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA GOMES DOS SANTOS IBCLC
Provider Business Mailing Address
First Line : 1660 E LAKE DR
Second Line :
City : MARIETTA
State : GA
Zip : 30062-2111
Country : US
Telephone Number : 704-622-3785
Fax Number :
Provider Business Practice Location Address
First Line : 3911 MARY ELIZA TRCE NW STE 200
Second Line :
City : MARIETTA
State : GA
Zip : 30064-1088
Country : US
Telephone Number : 678-384-3480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2020
Last Update Date : 01/30/2020

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