Provider Demographics
NPI:1437570355
Name:GORDON, CATHERINE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GORDON
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 1:33 LANSDALE CT
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0322
Mailing Address - Country:US
Mailing Address - Phone:949-315-9133
Mailing Address - Fax:
Practice Address - Street 1:33 LANSDALE CT
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0322
Practice Address - Country:US
Practice Address - Phone:949-315-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-18756163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant