Provider Demographics
NPI:1003502600
Name:VALENTIN, MAIDA (BS, IBCLC)
Entity Type:Individual
Prefix:
First Name:MAIDA
Middle Name:
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-6860
Mailing Address - Country:US
Mailing Address - Phone:551-209-4708
Mailing Address - Fax:
Practice Address - Street 1:60 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-6860
Practice Address - Country:US
Practice Address - Phone:551-209-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
NJL-125872174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education