Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | 43673 | NY |
N | 225700000X | Massage Therapist | 021538-01 | NY |
NPI | 1316256910 |
---|---|
Provider Name | Celena Degloma |
First Address | Brooklyn, NY 11215-3315 |
Second Address | Brooklyn, NY 11215-3315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2010 |
Last Update Date | 04/03/2021 |