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General NPI Number Information
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NPI Number | 1124972641
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Entity Type | Organization
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Legal Business Name | BLOOM THERAPY CLINIC LLC
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 1012 AVE DOS PALMAS
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City | TOA BAJA
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State | PR
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Zip | 00949-4101
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Country | US
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Telephone | 787-949-5557
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 CAMINO DEL MAR VIA CANGREJOS
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-949-5557
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHAMARYS D RIVERA SANTANA
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Credential | PSYD
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Telephone | 787-949-5557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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