Provider Demographics
NPI:1275354920
Name:BLOOM INK COLLECTIVE, LLC
Entity type:Organization
Organization Name:BLOOM INK COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TATTOO ARTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-402-2076
Mailing Address - Street 1:3434 BRAEBURN ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4039
Mailing Address - Country:US
Mailing Address - Phone:662-402-2076
Mailing Address - Fax:
Practice Address - Street 1:106 L ST STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-3227
Practice Address - Country:US
Practice Address - Phone:662-402-2076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty