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General NPI Number Information
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NPI Number | 1083398200
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Entity Type | Organization
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Legal Business Name | BLOSSOM NUTRITION LLC
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 904 JULY FOURTH RD
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City | MIDLAND
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State | TX
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Zip | 79706-1776
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Country | US
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Telephone | 903-312-4549
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Fax |
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Provider Business Mailing Address
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Address Line | 904 JULY FOURTH RD
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City | MIDLAND
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State | TX
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Zip | 79706-1776
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Country | US
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Telephone | 903-312-4549
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN/OWNER
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Name | JOSHUA MEI
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Credential | RD
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Telephone | 903-312-4549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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