Provider Demographics
NPI:1326898610
Name:VINTIMILLA, GLORIA MARGARITA (FULL SPECTRUM DOULA)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:MARGARITA
Last Name:VINTIMILLA
Suffix:
Gender:F
Credentials:FULL SPECTRUM DOULA
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:MARGARITA
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DOULA
Mailing Address - Street 1:3519 98TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1860
Mailing Address - Country:US
Mailing Address - Phone:929-451-5213
Mailing Address - Fax:
Practice Address - Street 1:3519 98TH ST # 2
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1860
Practice Address - Country:US
Practice Address - Phone:929-451-5213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYASDS1021374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty