| Bloom Mental Health And Wellness, Llc | |
|
1540 International Pkwy Ste 2000 Lake Mary FL 32746-5096 | |
| (407) 554-9970 | |
| Not Available |
| Full Name | Bloom Mental Health And Wellness, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1540 International Pkwy Ste 2000, Lake Mary, Florida |
| Authorized Official Name and Position | Lari J Quintero (OWNER) |
| Authorized Official Contact | 4072527011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Mental Health And Wellness, Llc 1540 International Pkwy Ste 2000 Lake Mary FL 32746-5096 Ph: (407) 252-7011 | Bloom Mental Health And Wellness, Llc 1540 International Pkwy Ste 2000 Lake Mary FL 32746-5096 Ph: (407) 554-9970 |
| NPI Number | 1285484204 |
|---|---|
| Provider Enumeration Date | 03/25/2024 |
| Last Update Date | 11/04/2024 |
| Certification Date | 11/04/2024 |
| Medicare PECOS PAC ID | 2567905870 |
|---|---|
| Medicare Enrollment ID | O20240614001948 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285484204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Lari J Quintero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811255599 PECOS PAC ID: 5698923068 Enrollment ID: I20120911000187 |
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