Provider Demographics
NPI:1306407218
Name:VERGARA, CHRISTY L (IBCLC)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:VERGARA
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:PO BOX 360205
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-0205
Mailing Address - Country:US
Mailing Address - Phone:321-414-9197
Mailing Address - Fax:
Practice Address - Street 1:209 FREDDIE ST
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2723
Practice Address - Country:US
Practice Address - Phone:575-551-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty