| Blossom Professional Psychology Corporation | |
|
3652 Jellyfish Ln Oxnard CA 93035-3049 | |
| (805) 666-9032 | |
| Not Available |
| Full Name | Blossom Professional Psychology Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 3652 Jellyfish Ln, Oxnard, California |
| Authorized Official Name and Position | Virna T Merino (CEO) |
| Authorized Official Contact | 8056669032 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Professional Psychology Corporation 3652 Jellyfish Ln Oxnard CA 93035-3049 Ph: (805) 666-9032 | Blossom Professional Psychology Corporation 3652 Jellyfish Ln Oxnard CA 93035-3049 Ph: (805) 666-9032 |
| NPI Number | 1235720244 |
|---|---|
| Provider Enumeration Date | 02/02/2021 |
| Last Update Date | 02/02/2021 |
| Certification Date | 02/01/2021 |
| Medicare PECOS PAC ID | 2961810924 |
|---|---|
| Medicare Enrollment ID | O20210413001023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235720244 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Virna Tehre Merino Landron |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396937843 PECOS PAC ID: 0244562767 Enrollment ID: I20191031003221 |
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