Provider Demographics
NPI:1750625299
Name:ENGEN, JUSTINA JO (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:JUSTINA
Middle Name:JO
Last Name:ENGEN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
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Mailing Address - Street 1:29601 BUTTERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-7425
Mailing Address - Country:US
Mailing Address - Phone:661-238-3066
Mailing Address - Fax:661-821-0409
Practice Address - Street 1:29601 BUTTERFIELD WAY
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-7425
Practice Address - Country:US
Practice Address - Phone:661-238-3066
Practice Address - Fax:661-821-0409
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN