Provider Demographics
NPI:1801331749
Name:PAUL-VOGEL, MICHELLE (BS, IBCLC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:PAUL-VOGEL
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:MOSS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:94038-9716
Mailing Address - Country:US
Mailing Address - Phone:650-207-0322
Mailing Address - Fax:
Practice Address - Street 1:614 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:MOSS BEACH
Practice Address - State:CA
Practice Address - Zip Code:94038-9716
Practice Address - Country:US
Practice Address - Phone:650-207-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-26090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL-26090OtherINTERNATIONAL BOARD LACTATION CONSULTANT EXAMINERS