Healthcare Provider Details

I. General information

NPI: 1588472872
Provider Name (Legal Business Name): BLOOMING ANGELS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 PARK WAY APT J
CHULA VISTA CA
91910-3659
US

IV. Provider business mailing address

583 PARK WAY APT J
CHULA VISTA CA
91910-3659
US

V. Phone/Fax

Practice location:
  • Phone: 619-508-4767
  • Fax:
Mailing address:
  • Phone: 619-508-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH LAURA ARROYO
Title or Position: NUTRITIONIST
Credential:
Phone: 619-508-4767