Provider Demographics
NPI:1568129880
Name:KEEPING IT SIMPLY SUPPLIED LACTATION SERVICES
Entity Type:Organization
Organization Name:KEEPING IT SIMPLY SUPPLIED LACTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:DENLEY
Authorized Official - Last Name:FARINA
Authorized Official - Suffix:
Authorized Official - Credentials:BA,RN, IBCLC
Authorized Official - Phone:424-391-5679
Mailing Address - Street 1:2904 W 133RD ST
Mailing Address - Street 2:N/A
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249
Mailing Address - Country:US
Mailing Address - Phone:131-075-3714
Mailing Address - Fax:
Practice Address - Street 1:2904 W 133RD ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-1519
Practice Address - Country:US
Practice Address - Phone:424-391-5679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty