Healthcare Provider Details

I. General information

NPI: 1881383057
Provider Name (Legal Business Name): BLOOMING CHILD DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 S FAIRFAX AVE
LOS ANGELES CA
90019-4402
US

IV. Provider business mailing address

8901 BURTON WAY APT 401
LOS ANGELES CA
90048-3787
US

V. Phone/Fax

Practice location:
  • Phone: 310-927-0126
  • Fax: 310-362-8943
Mailing address:
  • Phone: 310-927-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ABBY ABERASH TEKIE
Title or Position: OWNER
Credential: BCBA
Phone: 310-634-4444