Provider Demographics
NPI:1164061206
Name:SIEBOLD, SARAH (IBCLC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SIEBOLD
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 1:537 N LAS PALMAS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1017
Mailing Address - Country:US
Mailing Address - Phone:310-666-6217
Mailing Address - Fax:
Practice Address - Street 1:537 N LAS PALMAS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1017
Practice Address - Country:US
Practice Address - Phone:310-666-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN