Provider Demographics
NPI:1588319099
Name:BARAGIOLA, TINA LOUISE
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:BARAGIOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:LOUISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CD, SPBCPE
Mailing Address - Street 1:2243 XIMENO AVE # G
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2543
Mailing Address - Country:US
Mailing Address - Phone:310-461-9638
Mailing Address - Fax:
Practice Address - Street 1:540 N MARINE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5528
Practice Address - Country:US
Practice Address - Phone:310-461-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula