Organization
ORIGIN PREGNANCY BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY DAVIS RDMS (OWNER/SONOGRAPHER)
(707) 937-1477
Entity
Organization
Contact information
Practice address
45040 MAIN STREET, B, MENDOCINO, CA 95460
(707) 937-1477
(707) 937-1480
Mailing address
33275 PACIFIC WAY, FORT BRAGG, CA 95437-9226
(707) 937-1477
(707) 937-1480
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary
RDMS81478
CA
Other
Enumeration date
01/08/2010
Last updated
01/08/2010
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