Provider Demographics
NPI:1518793421
Name:BLOSSOM HEALTH CENTER
Entity type:Organization
Organization Name:BLOSSOM HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AP
Authorized Official - Prefix:DR
Authorized Official - First Name:CORI
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-985-1002
Mailing Address - Street 1:6273 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6273 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1343
Practice Address - Country:US
Practice Address - Phone:407-985-1002
Practice Address - Fax:407-440-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty