MEDICARE: OCEAN BLOOM ABA CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558224824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN BLOOM ABA CENTER LLC

Provider Business Mailing Address
First Line	:	5783 BAYSHORE RD STE 114
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-3006
Country	:	US
Telephone Number	:	786-556-3861
Fax Number	:

Provider Business Practice Location Address
First Line	:	5783 BAYSHORE RD STE 114
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-3006
Country	:	US
Telephone Number	:	786-556-3861
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDRES FELIX ESPINOSA DE LOS MONTEROS
Credential	:
Telephone Number	:	786-556-3861

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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