Provider Demographics
NPI:1982997425
Name:FULL BLOOM PEDIATRICS, LLC
Entity Type:Organization
Organization Name:FULL BLOOM PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SETTLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-532-6006
Mailing Address - Street 1:4181 CAMINO COYOTE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7096
Mailing Address - Country:US
Mailing Address - Phone:575-532-6006
Mailing Address - Fax:575-532-9049
Practice Address - Street 1:4181 CAMINO COYOTE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7096
Practice Address - Country:US
Practice Address - Phone:575-532-6006
Practice Address - Fax:575-532-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty