Organization
MENDED & MADE WELL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATRICE MARIE REID IBCLC (CHIEF EXECUTIVE OFFICER)
(619) 302-8691
Entity
Organization
Contact information
Practice address
9211 AMYS ST APT 30, SPRING VALLEY, CA 91977-3992
(619) 302-8691
Mailing address
9211 AMYS ST APT 30, SPRING VALLEY, CA 91977-3992
(619) 302-8691
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
374J00000X
Doula
—
—
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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