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General NPI Number Information
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NPI Number | 1295135499
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Entity Type | Organization
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Legal Business Name | BEYOND BLISS WELLNESS, LLC
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 236 5TH AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-3156
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Country | US
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Telephone | 321-536-5684
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Fax |
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Provider Business Mailing Address
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Address Line | 1884 TERRACE SHORES DR
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City | INDIALANTIC
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State | FL
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Zip | 32903-2737
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOREN KRIZMANICH
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Credential | CYT, EMT-1
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Telephone | 321-536-5684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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