Healthcare Provider Details

I. General information

NPI: 1629984216
Provider Name (Legal Business Name): BLOOMING KEIKI BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11623 SUNSAIL AVE
ORLANDO FL
32832-3007
US

IV. Provider business mailing address

11623 SUNSAIL AVE
ORLANDO FL
32832-3007
US

V. Phone/Fax

Practice location:
  • Phone: 808-333-7464
  • Fax:
Mailing address:
  • Phone: 808-333-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LUCYLIN SANTANA SOTO
Title or Position: OWNER
Credential:
Phone: 808-333-7464