Provider Demographics
NPI:1710503966
Name:GOLDILACTS LACTATION CONSULTATION
Entity Type:Organization
Organization Name:GOLDILACTS LACTATION CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER, CBS
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEVERRIA
Authorized Official - Suffix:
Authorized Official - Credentials:CBS
Authorized Official - Phone:818-428-8271
Mailing Address - Street 1:6606 ENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5608
Mailing Address - Country:US
Mailing Address - Phone:805-835-2777
Mailing Address - Fax:
Practice Address - Street 1:6606 ENFIELD AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5608
Practice Address - Country:US
Practice Address - Phone:805-835-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care