Healthcare Provider Details

I. General information

NPI: 1235093014
Provider Name (Legal Business Name): DARLA MINERVA TAVAREZ GRULLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W 127TH, NEW YORK, NY NMPP
NEW YORK NY
10027
US

IV. Provider business mailing address

1561 STERLING PL APT 2C
BROOKLYN NY
11213-3298
US

V. Phone/Fax

Practice location:
  • Phone: 212-665-2600
  • Fax:
Mailing address:
  • Phone: 929-899-8193
  • 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: