Provider Demographics
NPI:1356627525
Name:KNOLL, MARIA PASTOR (MSN, CNM, IBCLC, CNL)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:PASTOR
Last Name:KNOLL
Suffix:
Gender:F
Credentials:MSN, CNM, IBCLC, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5543
Mailing Address - Country:US
Mailing Address - Phone:805-527-2299
Mailing Address - Fax:805-527-2299
Practice Address - Street 1:746 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5543
Practice Address - Country:US
Practice Address - Phone:805-527-2299
Practice Address - Fax:805-527-2299
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA737609163W00000X
CA11137856163WL0100X
CA236300367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant