# MY MOM GLOW LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** My Mom Glow
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790576957
- **Authorized official:** SANDRA ANN LOBAINA LM,CPM,IBCLC (OWNER)
- **Authorized official phone:** (305) 600-8109

## Contact information

- **Practice address:** 2750 N 29TH AVE STE 309, HOLLYWOOD, FL 33020-1521
- **Practice address phone:** (954) 880-1182
- **Practice address fax:** (954) 301-8385
- **Mailing address:** 320 SW 67TH TER, PEMBROKE PINES, FL 33023-1274
- **Mailing address phone:** (305) 600-8109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174N00000X | Lactation Consultant (Non-RN) | — | NULL | — |
| 174N00000X | Lactation Consultant (Non-RN) | — | — | — |
| 176B00000X | Midwife | — | NULL | Yes |
| 176B00000X | Midwife | — | — | Yes |

## Other

- **Enumeration date:** 05/15/2025
- **Last updated:** 05/15/2025