Provider Demographics
NPI:1881312023
Name:RUIZ SALGUERO, BETHANY GRACE (IBCLC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:GRACE
Last Name:RUIZ SALGUERO
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:GRACE
Other - Last Name:SALGUERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:163 DIVINITY ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6011
Mailing Address - Country:US
Mailing Address - Phone:860-845-7507
Mailing Address - Fax:
Practice Address - Street 1:163 DIVINITY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6011
Practice Address - Country:US
Practice Address - Phone:860-845-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL-129167174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN