Healthcare Provider Details

I. General information

NPI: 1700544897
Provider Name (Legal Business Name): BLOSSOM PEDIATRICS AND LACTATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 WEST LOOP S STE 290
BELLAIRE TX
77401-2913
US

IV. Provider business mailing address

6711 STELLA LINK RD # 109
HOUSTON TX
77005-4342
US

V. Phone/Fax

Practice location:
  • Phone: 713-322-6679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY CHAN-RAMIREZ
Title or Position: OWNER
Credential: MD
Phone: 713-322-6679