Healthcare Provider Details

I. General information

NPI: 1194445692
Provider Name (Legal Business Name): INFINITELY IMBUED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 STAMFORD AVE
PROVIDENCE RI
02907-3625
US

IV. Provider business mailing address

15 STAMFORD AVE
PROVIDENCE RI
02907-3625
US

V. Phone/Fax

Practice location:
  • Phone: 401-369-5175
  • Fax:
Mailing address:
  • Phone: 401-369-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACARINA SOTO
Title or Position: OWNER
Credential:
Phone: 401-369-5175