MEDICARE: BLOOM PEDIATRICS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1972143923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM PEDIATRICS

Provider Business Mailing Address
First Line	:	1523 WELLESLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3629
Country	:	US
Telephone Number	:	424-229-2570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 WELLESLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3629
Country	:	US
Telephone Number	:	424-229-2570
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	ADRIANE RANSOM
Credential	:	OTR/L
Telephone Number	:	424-229-2570

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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Directions to “BLOOM PEDIATRICS ” Practice Location

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