Provider Demographics
NPI:1639423858
Name:ZERMENO, ESTRELLA (IBCLC RLC)
Entity Type:Individual
Prefix:
First Name:ESTRELLA
Middle Name:
Last Name:ZERMENO
Suffix:
Gender:F
Credentials:IBCLC RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N 6TH AVE
Mailing Address - Street 2:APT 109W
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3765
Mailing Address - Country:US
Mailing Address - Phone:623-206-3871
Mailing Address - Fax:
Practice Address - Street 1:3620 N 6TH AVE
Practice Address - Street 2:APT 109W
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3765
Practice Address - Country:US
Practice Address - Phone:623-206-3871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10522279174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN