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General NPI Number Information
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NPI Number | 1164221347
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Entity Type | Organization
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Legal Business Name | ITHIOPIA LLC
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 10485 FOLSOM BVLD SUITE B
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone | 279-465-1236
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Fax |
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Provider Business Mailing Address
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Address Line | 10436 COLOMA RD # 22
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-2157
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Country | US
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Telephone | 279-465-1236
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ITHOPIA MCKINNEY
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Credential |
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Telephone | 279-465-1236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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