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General NPI Number Information
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NPI Number | 1679434088
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Entity Type | Organization
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Legal Business Name | BLOSSOM MEDICAL GROUP LLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 538 W MONTE VISTA AVE
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City | VACAVILLE
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State | CA
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Zip | 95688-3620
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Country | US
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Telephone | 678-792-0778
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Fax |
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Provider Business Mailing Address
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Address Line | 538 W MONTE VISTA AVE
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City | VACAVILLE
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State | CA
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Zip | 95688-3620
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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 | MD
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Name | JOSEFINA GUEVARA
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Credential |
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Telephone | 678-792-0778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number |
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License Number State |
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