Origin Pregnancy Boutique

NPI 1255661583 - Radiologic Technologist - 2471S1302X

NPI Details
NPI 1255661583
Enumeration Date 01/08/2010
Last Updated 01/08/2010
Entity Type Healthcare Provider
Active Over 6 years ago
Authorized Information
Name AMY AMY
Position OWNER/SONOGRAPHER
Phone (707) 937-1477
Fax (707) 937-1480
Practice Location
45040 MAIN STREET
B
MENDOCINO CA, 95460, US
Phone (707) 937-1477
Fax (707) 937-1480
Business Location
33275 PACIFIC WAY
FORT BRAGG CA, 95437-9226, US
Phone (707) 937-1477
Fax (707) 937-1480
Toxanomy
Taxonomy Code 2471S1302X
License State California
License Number RDMS81478
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According to our database, Origin Pregnancy Boutique NPI is 1255661583, taxonomy code is 2471S1302X and license number is RDMS81478, license state is located at California. Origin Pregnancy Boutique physically located at 45040 Main Street, Mendocino CA, 95460. NPI Number 1033115704 has the healthcare provider type.

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1255661583 NPI number is provided on an as is basis without warranty of any kind. 1255661583 is maintained by the National Plan & Provider Enumeration System. The contents of Origin Pregnancy Boutique are for informational purposes only.