Provider Demographics
NPI:1619633377
Name:EAST BAY LACTATION ASSOCIATES LLC
Entity Type:Organization
Organization Name:EAST BAY LACTATION ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:510-525-1155
Mailing Address - Street 1:1260B 45TH ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2907
Mailing Address - Country:US
Mailing Address - Phone:510-525-1155
Mailing Address - Fax:510-525-1155
Practice Address - Street 1:1260B 45TH ST
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2907
Practice Address - Country:US
Practice Address - Phone:510-525-1155
Practice Address - Fax:510-525-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE