Provider Demographics
NPI:1548470669
Name:BERKELEY, LIZABETH J (IBCLC)
Entity type:Individual
Prefix:
First Name:LIZABETH
Middle Name:J
Last Name:BERKELEY
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 1:1305 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4426
Mailing Address - Country:US
Mailing Address - Phone:915-546-9847
Mailing Address - Fax:915-545-7538
Practice Address - Street 1:1305 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4426
Practice Address - Country:US
Practice Address - Phone:915-546-9847
Practice Address - Fax:915-545-7538
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10117035174400000X
1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered1744R1102XOther Service ProvidersSpecialistResearch Study