Mary Clare Ovalle, RD, IBCLC

Primary specialty

Lactation Consultant (Non-RN)Taxonomy code 174N00000X

License

L-28731 Issued in CA

Practice address

10290 N Dearing Ave
Fresno, CA 93730-4772

Phone

(559) 304-0348

NPI assigned

Jan 24, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1093345423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10290 N DEARING AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937304772",
            "telephone_number": "559-304-0348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10290 N DEARING AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937304772",
            "telephone_number": "559-304-0348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OVALLE",
        "first_name": "MARY",
        "middle_name": "CLARE",
        "credential": "RD, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-24",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "655589",
            "primary": false
        },
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "CA",
            "license": "L-28731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Talar Anya Ourfalian
• Kaitlin Outfleet
• Boaz Ovadia, M.D.
• Eric Ovalle
• Mao Ovalle
• Richard Xavier Ovalle Jr.
• Bryan Ovalles
• Marissa Overstreet, BA, BCAT
• Steven Overstreet
• Tina Marie Overstreet, BA, PA-C

• Lactation Consultant (Non-RN) in Fresno, CA
• Providers in Fresno, CA by specialty
• Lactation Consultant (Non-RN) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.