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General NPI Number Information
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NPI Number | 1861282477
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Entity Type | Organization
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Legal Business Name | DIVINE ANCESTORS BIRTHWORKS LLC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 2036 RENZ RD
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City | DURHAM
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State | CA
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Zip | 95938-9627
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Country | US
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Telephone | 925-392-5878
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 RENZ RD
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City | DURHAM
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State | CA
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Zip | 95938-9627
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Country | US
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Telephone | 925-392-5878
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | MS. EBONIE C MEGIBOW
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Credential | MPH
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Telephone | 963-669-6270
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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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