Provider Demographics
NPI:1629800107
Name:BLOOM WELLNESS CLINICS, LLC
Entity type:Organization
Organization Name:BLOOM WELLNESS CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-707-9050
Mailing Address - Street 1:9755 N 90TH ST STE B295
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5071
Mailing Address - Country:US
Mailing Address - Phone:480-707-9050
Mailing Address - Fax:602-429-8540
Practice Address - Street 1:9755 N 90TH ST STE B295
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5071
Practice Address - Country:US
Practice Address - Phone:480-707-9050
Practice Address - Fax:602-429-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty