Provider Demographics
NPI:1619608320
Name:MARTI REYES, DORACELIS GISSELLE (DOULA)
Entity Type:Individual
Prefix:
First Name:DORACELIS
Middle Name:GISSELLE
Last Name:MARTI REYES
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 1:8715 NE 108TH CIR UNIT 206
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32162-8810
Mailing Address - Country:US
Mailing Address - Phone:352-702-2065
Mailing Address - Fax:
Practice Address - Street 1:8715 NE 108TH CIR UNIT 206
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32162-8810
Practice Address - Country:US
Practice Address - Phone:352-702-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR374J00000X
FL374J00000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN