Provider Demographics
NPI:1801173794
Name:GACIA, CYNDI (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:CYNDI
Middle Name:
Last Name:GACIA
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 1:2436 S 107TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-4812
Mailing Address - Country:US
Mailing Address - Phone:918-978-1551
Mailing Address - Fax:
Practice Address - Street 1:2436 S 107TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-4812
Practice Address - Country:US
Practice Address - Phone:918-978-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11199334174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN