Provider Demographics
NPI:1003197864
Name:SUFFIN, JENNIFER LIZA (IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LIZA
Last Name:SUFFIN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 RALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5109
Mailing Address - Country:US
Mailing Address - Phone:415-939-7877
Mailing Address - Fax:
Practice Address - Street 1:66 PROSPER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1609
Practice Address - Country:US
Practice Address - Phone:415-939-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-33935174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-33935OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS