Provider Demographics
NPI:1730936238
Name:CRISAFI, CAROLINA CORONADO (IBCLC)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:CORONADO
Last Name:CRISAFI
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 1:5981 SW 69TH AVE FL 33143
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-1939
Mailing Address - Country:US
Mailing Address - Phone:786-210-7525
Mailing Address - Fax:
Practice Address - Street 1:5981 SW 69TH AVE FL 33143
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-1939
Practice Address - Country:US
Practice Address - Phone:786-210-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-312396174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN