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General NPI Number Information
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NPI Number | 1700544897
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Entity Type | Organization
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Legal Business Name | BLOSSOM PEDIATRICS AND LACTATION, PLLC
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 6300 WEST LOOP S STE 290
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City | BELLAIRE
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State | TX
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Zip | 77401-2913
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Country | US
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Telephone | 713-322-6679
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Fax |
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Provider Business Mailing Address
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Address Line | 6711 STELLA LINK RD # 109
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City | HOUSTON
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State | TX
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Zip | 77005-4342
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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 | SHIRLEY CHAN-RAMIREZ
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Credential | MD
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Telephone | 713-322-6679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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