Healthcare Provider Details

I. General information

NPI: 1891659074
Provider Name (Legal Business Name): IN BLOOM AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

951 NW 13TH ST STE 4A
BOCA RATON FL
33486-2337
US

IV. Provider business mailing address

951 NW 13TH ST STE 4A
BOCA RATON FL
33486-2337
US

V. Phone/Fax

Practice location:
  • Phone: 561-393-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NIDIA HAYDEE DE JESUS
Title or Position: MANAGER
Credential: MD
Phone: 561-393-6400