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General NPI Number Information
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NPI Number | 1770399586
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Entity Type | Organization
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Legal Business Name | BLOOMING BELLIES ULTRASOUND BOUTIQUE LLC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 5851 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60634-2609
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Country | US
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Telephone | 312-560-5585
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Fax |
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Provider Business Mailing Address
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Address Line | 4043 N MARMORA AVE
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City | CHICAGO
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State | IL
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Zip | 60634-1728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SONOGRAPHER
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Name | MRS. SONNET PACHECO
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Credential | RDMS
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Telephone | 773-573-9578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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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 | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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