Provider Demographics
NPI:1003649856
Name:MARCIAL, LEILA ELENA (CM, CD, CCE)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:ELENA
Last Name:MARCIAL
Suffix:
Gender:F
Credentials:CM, CD, CCE
Other - Prefix:
Other - First Name:LEILA ELENA
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CM, CCE, CD
Mailing Address - Street 1:100 QUAKER CHURCH RD
Mailing Address - Street 2:#11-6,
Mailing Address - City:RANDOLPH (NEW JERSEY)
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:862-251-3841
Mailing Address - Fax:
Practice Address - Street 1:100 QUAKER CHURCH RD
Practice Address - Street 2:#11-6,
Practice Address - City:RANDOLPH (NEW JERSEY)
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:862-251-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNONE374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula