Provider Demographics
NPI:1962813717
Name:GOLDBACH, VICKI (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:GOLDBACH
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 S GERTRUDA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4243
Mailing Address - Country:US
Mailing Address - Phone:310-874-2438
Mailing Address - Fax:
Practice Address - Street 1:544 S GERTRUDA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4243
Practice Address - Country:US
Practice Address - Phone:310-874-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383956163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant