Provider Demographics
NPI:1396019949
Name:STARK, EVA (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:
Last Name:STARK
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 1:23631 VIA NAVARRA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3635
Mailing Address - Country:US
Mailing Address - Phone:949-455-0360
Mailing Address - Fax:
Practice Address - Street 1:23631 VIA NAVARRA
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3635
Practice Address - Country:US
Practice Address - Phone:949-455-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10935709174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10935709OtherIBCLE