Provider Demographics
NPI:1083758650
Name:DOMINGUEZ, GLORIA MARGARITA (CNM)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:MARGARITA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MOTT ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5540
Mailing Address - Country:US
Mailing Address - Phone:212-219-2723
Mailing Address - Fax:212-219-3086
Practice Address - Street 1:128 MOTT ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5540
Practice Address - Country:US
Practice Address - Phone:212-219-2723
Practice Address - Fax:212-219-3086
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000809176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02179711Medicaid