Healthcare Provider Details

I. General information

NPI: 1477010775
Provider Name (Legal Business Name): AISOLEN MARCIAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 02/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WILLIS AVE APT 6K
BRONX NY
10454-4547
US

IV. Provider business mailing address

105 WILLIS AVE APT 6K
BRONX NY
10454-4547
US

V. Phone/Fax

Practice location:
  • Phone: 646-678-0102
  • Fax:
Mailing address:
  • Phone: 646-678-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: