Provider Demographics
NPI:1376912899
Name:VIVIEN EARTHMAN
Entity Type:Organization
Organization Name:VIVIEN EARTHMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:EARTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:949-232-3605
Mailing Address - Street 1:6 VIRGIL CT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92617-4053
Mailing Address - Country:US
Mailing Address - Phone:949-232-3605
Mailing Address - Fax:
Practice Address - Street 1:6 VIRGIL CT
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92617-4053
Practice Address - Country:US
Practice Address - Phone:949-232-3605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437003261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing