Provider Demographics
NPI:1205106689
Name:BLOOM & SPEAK BILINGUAL TX LLC
Entity type:Organization
Organization Name:BLOOM & SPEAK BILINGUAL TX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRISIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-241-6442
Mailing Address - Street 1:PO BOX 15774
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-5774
Mailing Address - Country:US
Mailing Address - Phone:480-648-3502
Mailing Address - Fax:480-499-5879
Practice Address - Street 1:4848 E ROOSEVELT ST
Practice Address - Street 2:APT. 2037
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7327
Practice Address - Country:US
Practice Address - Phone:480-648-3502
Practice Address - Fax:480-499-5879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA74272355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty