MEDICARE: 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	174N00000X	Lactation Consultant (Non-RN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82-5482653	OTHER	FL	LACTATION

General Provider Information

NPI Number	:	1982319265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACTATION LLC

Provider Business Mailing Address
First Line	:	4539 SW 15TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6314
Country	:	US
Telephone Number	:	239-851-0909
Fax Number	:	866-229-4468

Provider Business Practice Location Address
First Line	:	4539 SW 15TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6314
Country	:	US
Telephone Number	:	239-851-0909
Fax Number	:	866-229-4468

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	JUANA M RODRIGUEZ
Credential	:	BS,IBCLC
Telephone Number	:	239-851-0909

Provider Enumeration Date	:	01/20/2023
Last Update Date	:	01/20/2023

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