Provider Demographics
NPI:1043910680
Name:CUKJATI, ALICIA EVE (IBCLC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:EVE
Last Name:CUKJATI
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 1:3817 ANDERS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2582
Mailing Address - Country:US
Mailing Address - Phone:916-316-7144
Mailing Address - Fax:
Practice Address - Street 1:3817 ANDERS WAY
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2582
Practice Address - Country:US
Practice Address - Phone:916-316-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-152205174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN