Provider Demographics
NPI:1982203667
Name:CONRIQUEZ, PAULA (IBCLC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CONRIQUEZ
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 1:6230 DROP OFF RD
Mailing Address - Street 2:
Mailing Address - City:POLLOCK PINES
Mailing Address - State:CA
Mailing Address - Zip Code:95726-9633
Mailing Address - Country:US
Mailing Address - Phone:916-217-3910
Mailing Address - Fax:916-265-2863
Practice Address - Street 1:6230 DROP OFF RD
Practice Address - Street 2:
Practice Address - City:POLLOCK PINES
Practice Address - State:CA
Practice Address - Zip Code:95726-9633
Practice Address - Country:US
Practice Address - Phone:916-217-3910
Practice Address - Fax:916-265-2863
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-49706OtherIBCLE