Provider Demographics
NPI:1013368109
Name:BUCCOLO, GINA M (IBCLC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:BUCCOLO
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 1:1966 LUNDY AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1056
Mailing Address - Country:US
Mailing Address - Phone:626-644-5483
Mailing Address - Fax:
Practice Address - Street 1:1966 LUNDY AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1056
Practice Address - Country:US
Practice Address - Phone:626-644-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN