Healthcare Provider Details

I. General information

NPI: 1427960921
Provider Name (Legal Business Name): BLOOM PEDIATRIC THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13211 MYFORD RD APT 1011
TUSTIN CA
92782-9170
US

IV. Provider business mailing address

13211 MYFORD RD APT 1011
TUSTIN CA
92782-9170
US

V. Phone/Fax

Practice location:
  • Phone: 949-533-8545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: VANESSA SUAREZ
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 949-294-8069