Healthcare Provider Details

I. General information

NPI: 1710866306
Provider Name (Legal Business Name): BLOOMING WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAR 2 R475 K2 H0 INT BO ARENALES ALTOS/ SECT CUBER
ISABELA PR
00662
US

IV. Provider business mailing address

431 CALLE ANGOLA
ISABELA PR
00662-6120
US

V. Phone/Fax

Practice location:
  • Phone: 787-955-0248
  • Fax:
Mailing address:
  • Phone: 787-955-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. IRIANA M NAVARRO
Title or Position: DIRECTOR
Credential: PSY. D
Phone: 787-955-0248