Provider Demographics
NPI:1770308298
Name:BERUMEN OSEGUERA, SUSANA (IBCLC)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:BERUMEN OSEGUERA
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 1:80773 DESERT SPUR DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-8328
Mailing Address - Country:US
Mailing Address - Phone:760-409-8076
Mailing Address - Fax:
Practice Address - Street 1:80773 DESERT SPUR DR
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-8328
Practice Address - Country:US
Practice Address - Phone:760-409-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-30360174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty