Provider Demographics
NPI:1326619149
Name:BOOTH, CATHY ROSE (RNC IBCLC CIMI)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:ROSE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:RNC IBCLC CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ASHBY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2067
Mailing Address - Country:US
Mailing Address - Phone:510-204-6546
Mailing Address - Fax:
Practice Address - Street 1:2450 ASHBY AVE RM 1190
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2067
Practice Address - Country:US
Practice Address - Phone:510-294-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406983163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant