Provider Demographics
NPI:1447068994
Name:FASSHAUER ESCOBAR, ELIZABETH BEATRIZ (IBCLC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BEATRIZ
Last Name:FASSHAUER ESCOBAR
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 1:56 E 1100 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-1700
Mailing Address - Country:US
Mailing Address - Phone:703-945-8306
Mailing Address - Fax:
Practice Address - Street 1:56 E 1100 N
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-1700
Practice Address - Country:US
Practice Address - Phone:703-945-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTL-317399174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN