Provider Demographics
NPI:1790929636
Name:MATERNAL INFANT LACTATION CENTER
Entity Type:Organization
Organization Name:MATERNAL INFANT LACTATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-337-6452
Mailing Address - Street 1:10775 DOUBLE R BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8980
Mailing Address - Country:US
Mailing Address - Phone:775-337-6452
Mailing Address - Fax:
Practice Address - Street 1:10775 DOUBLE R BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8980
Practice Address - Country:US
Practice Address - Phone:775-337-6452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty