=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639029523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLOSSOM SPEECH & LANGUAGE PATHOLOGY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2026
-----------------------------------------------------
Last Update Date | 01/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1080 S LA CIENEGA BLVD STE 309
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90035-2680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-943-5116
-----------------------------------------------------
Fax | 888-435-8980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1080 S LA CIENEGA BLVD STE 309
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90035-2680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-943-5116
-----------------------------------------------------
Fax | 888-435-8980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MIRIAM SHIMONI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-943-5116
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------