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General NPI Number Information
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NPI Number | 1972143923
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Entity Type | Organization
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Legal Business Name | BLOOM PEDIATRICS
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 1523 WELLESLEY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-3629
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Country | US
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Telephone | 424-229-2570
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 WELLESLEY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-3629
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Country | US
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Telephone | 424-229-2570
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | ADRIANE RANSOM
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Credential | OTR/L
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Telephone | 424-229-2570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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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 | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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