Healthcare Provider Details

I. General information

NPI: 1518771617
Provider Name (Legal Business Name): BLOSSOMING COMMUNICATION SPEECH THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4342 KATELLA AVE
LOS ALAMITOS CA
90720-3573
US

IV. Provider business mailing address

5132 PREMIERE AVE
LAKEWOOD CA
90712-2714
US

V. Phone/Fax

Practice location:
  • Phone: 562-231-7174
  • Fax:
Mailing address:
  • Phone: 562-231-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIA OBENHAUS
Title or Position: OWNER
Credential: SLP
Phone: 562-231-7141