Provider Demographics
NPI:1023709441
Name:DEL RIO, MYLENE (CERTIFIED BIRTH DOUL)
Entity type:Individual
Prefix:
First Name:MYLENE
Middle Name:
Last Name:DEL RIO
Suffix:
Gender:F
Credentials:CERTIFIED BIRTH DOUL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-3505
Mailing Address - Country:US
Mailing Address - Phone:727-674-5133
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR STE 2019
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:727-674-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL202304112374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula