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General NPI Number Information
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NPI Number | 1396485710
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Entity Type | Organization
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Legal Business Name | BLOOM FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 7341 OFFICE PARK PL STE 202B
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City | MELBOURNE
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State | FL
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Zip | 32940-8280
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Country | US
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Telephone | 302-344-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 3288 CAPPIO DR
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City | MELBOURNE
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State | FL
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Zip | 32940-1310
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Country | US
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Telephone | 302-650-7961
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. CHRISTINA HABIB BOVELSKY
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Credential | MD
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Telephone | 302-650-7961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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