Provider Demographics
NPI:1912616608
Name:VILLATE, CAMILLIA BIANCA (IBCLC)
Entity Type:Individual
Prefix:
First Name:CAMILLIA
Middle Name:BIANCA
Last Name:VILLATE
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 1:2619 VANDERBILT LN UNIT C
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3488
Mailing Address - Country:US
Mailing Address - Phone:323-363-8345
Mailing Address - Fax:
Practice Address - Street 1:2619 VANDERBILT LN UNIT C
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3488
Practice Address - Country:US
Practice Address - Phone:323-363-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-111295174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL-111295OtherIBCLC