Healthcare Provider Details

I. General information

NPI: 1598683872
Provider Name (Legal Business Name): BLOOM WELLNESS AND AESTHETICS BY LAUREN E., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19770 LENAIRE DR
CUTLER BAY FL
33157-8551
US

IV. Provider business mailing address

19770 LENAIRE DR
CUTLER BAY FL
33157-8551
US

V. Phone/Fax

Practice location:
  • Phone: 786-352-5100
  • Fax:
Mailing address:
  • Phone: 786-352-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAUREN E. FRIAS
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 786-352-5100