Provider Demographics
NPI:1811711310
Name:MEGIBOW, EBONIE C
Entity type:Individual
Prefix:
First Name:EBONIE
Middle Name:C
Last Name:MEGIBOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 SANTOS LN APT 101
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7571
Mailing Address - Country:US
Mailing Address - Phone:863-669-6270
Mailing Address - Fax:
Practice Address - Street 1:2991 SANTOS LN APT 101
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-7571
Practice Address - Country:US
Practice Address - Phone:863-669-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula