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General NPI Number Information
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NPI Number | 1558184945
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Entity Type | Organization
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Legal Business Name | BLOSSOM GARDEN
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 3122 W MAYWOOD AVENUE
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City | ANAHEIM
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State | CA
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Zip | 92804
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Country | US
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Telephone | 714-406-3220
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Fax | 714-460-1341
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Provider Business Mailing Address
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Address Line | 1950 W CORPORATE WAY STE 31936
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City | ANAHEIM
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State | CA
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Zip | 92801-5373
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Country | US
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Telephone | 714-406-3220
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Fax | 714-460-1341
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Authorized Official
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Title or Position | OWNER
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Name | AYA RICHED
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Credential | BCBA
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Telephone | 714-872-7876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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