Provider Demographics
NPI:1376123661
Name:RADINSKY, MARY MARTHA (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARTHA
Last Name:RADINSKY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 N LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-2627
Mailing Address - Country:US
Mailing Address - Phone:310-963-3392
Mailing Address - Fax:
Practice Address - Street 1:543 N LELAND AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-2627
Practice Address - Country:US
Practice Address - Phone:310-963-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL108117163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant