Healthcare Provider Details

I. General information

NPI: 1417812223
Provider Name (Legal Business Name): BLOOM WITHIN COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 VENTURE STE 355
IRVINE CA
92618-7369
US

IV. Provider business mailing address

24443 BORREGO CIR
CORONA CA
92883-5159
US

V. Phone/Fax

Practice location:
  • Phone: 949-306-3026
  • Fax:
Mailing address:
  • Phone: 949-306-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BAHAREH SAIDIAN
Title or Position: AUTHORIZED OFFICIAL
Credential: LCSW
Phone: 949-306-3026