Provider Demographics
NPI:1528583226
Name:THE MILK COLLECTIVE, LLC
Entity Type:Organization
Organization Name:THE MILK COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:305-928-5868
Mailing Address - Street 1:7920 NW 172ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3851
Mailing Address - Country:US
Mailing Address - Phone:305-928-5868
Mailing Address - Fax:
Practice Address - Street 1:14601 SW 29TH ST STE 303
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4714
Practice Address - Country:US
Practice Address - Phone:305-928-5868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty