Provider Demographics
NPI:1194077032
Name:PAGLIARULO-WALLACE, MONICA THERESA (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:THERESA
Last Name:PAGLIARULO-WALLACE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:THERESA
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:353 N SWINTON AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-2725
Mailing Address - Country:US
Mailing Address - Phone:561-729-6837
Mailing Address - Fax:
Practice Address - Street 1:353 N SWINTON AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-2725
Practice Address - Country:US
Practice Address - Phone:561-729-6837
Practice Address - Fax:561-952-0856
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW326176B00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula