Provider Demographics
NPI:1770399586
Name:BLOOMING BELLIES ULTRASOUND BOUTIQUE LLC
Entity type:Organization
Organization Name:BLOOMING BELLIES ULTRASOUND BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SONOGRAPHER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONNET
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:773-573-9578
Mailing Address - Street 1:4043 N MARMORA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5851 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2609
Practice Address - Country:US
Practice Address - Phone:312-560-5585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty