Healthcare Provider Details

I. General information

NPI: 1235689910
Provider Name (Legal Business Name): BELISSA BLOMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14181 TELEGRAPH RD
WHITTIER CA
90604-2554
US

IV. Provider business mailing address

1501 HUGHES WAY STE 150
LONG BEACH CA
90810-1878
US

V. Phone/Fax

Practice location:
  • Phone: 562-273-0722
  • Fax:
Mailing address:
  • Phone: 310-221-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC44943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: