Provider Demographics
NPI:1467028837
Name:VARGAS, CORALYS (DOULA)
Entity Type:Individual
Prefix:
First Name:CORALYS
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORN MILL WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1293
Mailing Address - Country:US
Mailing Address - Phone:857-334-1390
Mailing Address - Fax:
Practice Address - Street 1:15 CORN MILL WAY
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1293
Practice Address - Country:US
Practice Address - Phone:857-334-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4264174N00000X
PA4412374J00000X
PA4256374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN