Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F000809 | NY |
NPI | 1083758650 |
---|---|
Provider Name | Ms. Gloria Margarita Dominguez |
First Address | New York, NY 10013-5540 |
Second Address | New York, NY 10013-5540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 18/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02179711 | (05) | NY |