Healthcare Provider Details

I. General information

NPI: 1003649856
Provider Name (Legal Business Name): LEILA ELENA MARCIAL CM, CD, CCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEILA ELENA AGUILAR CM, CCE, CD

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 QUAKER CHURCH RD #11-6,
RANDOLPH (NEW JERSEY) NJ
07869
US

IV. Provider business mailing address

100 QUAKER CHURCH RD #11-6,
RANDOLPH (NEW JERSEY) NJ
07869
US

V. Phone/Fax

Practice location:
  • Phone: 862-251-3841
  • Fax:
Mailing address:
  • Phone: 862-251-3841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberNONE
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: