Provider Demographics
NPI:1114519220
Name:LILIENTHAL, BETH (CLEC, PCD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LILIENTHAL
Suffix:
Gender:F
Credentials:CLEC, PCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9334
Mailing Address - Country:US
Mailing Address - Phone:831-588-7367
Mailing Address - Fax:
Practice Address - Street 1:999 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:BEN LOMOND
Practice Address - State:CA
Practice Address - Zip Code:95005-9334
Practice Address - Country:US
Practice Address - Phone:831-588-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN