Healthcare Provider Details

I. General information

NPI: 1659830628
Provider Name (Legal Business Name): BRIA COAXUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/05/2026
Certification Date:
Deactivation Date: 06/23/2025
Reactivation Date: 08/05/2026

III. Provider practice location address

150 BAINBRIDGE ST
BROOKLYN NY
11233-1802
US

IV. Provider business mailing address

150 BAINBRIDGE ST
BROOKLYN NY
11233-1802
US

V. Phone/Fax

Practice location:
  • Phone: 718-594-4213
  • Fax:
Mailing address:
  • Phone: 718-594-4213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: