Provider Demographics
NPI:1457039232
Name:BLOSSOM BLISS LLC
Entity Type:Organization
Organization Name:BLOSSOM BLISS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:FLORES-NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:DOULA LACTATION SUPP
Authorized Official - Phone:770-906-7275
Mailing Address - Street 1:111 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4280
Mailing Address - Country:US
Mailing Address - Phone:770-906-7275
Mailing Address - Fax:
Practice Address - Street 1:111 DRIFTWOOD LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4280
Practice Address - Country:US
Practice Address - Phone:770-906-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty