Provider Demographics
NPI:1881409886
Name:MATIAS-NUNEZ, ROSA (IBCLC)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:MATIAS-NUNEZ
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 1:452 STILLSON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3118
Mailing Address - Country:US
Mailing Address - Phone:845-542-3864
Mailing Address - Fax:
Practice Address - Street 1:452 STILLSON RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-3118
Practice Address - Country:US
Practice Address - Phone:845-542-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-303313174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN