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Organization
ANCESTRAL LACTATION LLC
Active
Organization
ANCESTRAL LACTATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIREYA GONZALEZ MPH, IBCLC (EXECUTIVE DIRECTOR)
(818) 747-4292
Entity
Organization
Contact information
Practice address
14621 VAN NUYS PL, PANORAMA CITY, CA 91402-1024
(818) 747-4292
Mailing address
14621 VAN NUYS PL, PANORAMA CITY, CA 91402-1024
(818) 747-4292
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
174N00000X
Lactation Consultant (Non-RN)
—
—
374J00000X
Doula
Primary
—
—
Other
Enumeration date
09/14/2023
Last updated
09/14/2023
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