Provider Demographics
NPI:1790499986
Name:SALDIVAR LARA, ANA ROSA (IBCLC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ROSA
Last Name:SALDIVAR LARA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4938 N MONTE CRISTO WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-5808
Mailing Address - Country:US
Mailing Address - Phone:702-232-0644
Mailing Address - Fax:
Practice Address - Street 1:4938 N MONTE CRISTO WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-5808
Practice Address - Country:US
Practice Address - Phone:702-232-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVL-307059174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
15833189OtherCAQH