Provider Demographics
NPI:1922757749
Name:ABC LACTATION
Entity Type:Organization
Organization Name:ABC LACTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELLE
Authorized Official - Middle Name:LAURE
Authorized Official - Last Name:FRAISSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:415-335-6576
Mailing Address - Street 1:922 ESMERALDA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5257
Mailing Address - Country:US
Mailing Address - Phone:415-200-6510
Mailing Address - Fax:
Practice Address - Street 1:922 ESMERALDA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5257
Practice Address - Country:US
Practice Address - Phone:415-335-6576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty