Provider Demographics
NPI:1023358496
Name:MAMA'S LATTE LLC
Entity Type:Organization
Organization Name:MAMA'S LATTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LACTATION CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIBYLLE
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:RUNDEL
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:520-628-4202
Mailing Address - Street 1:330 E. MORNING SUN CT.
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-0000
Mailing Address - Country:US
Mailing Address - Phone:520-628-4202
Mailing Address - Fax:520-797-1830
Practice Address - Street 1:330 E MORNING SUN CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6946
Practice Address - Country:US
Practice Address - Phone:520-628-4202
Practice Address - Fax:520-797-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ143903174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty