Provider Demographics
NPI:1336957331
Name:BLOSSOM BIRTH & GROW
Entity type:Organization
Organization Name:BLOSSOM BIRTH & GROW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOULA/MIDWIFE ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:EPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-909-8507
Mailing Address - Street 1:3431 W 67TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-4316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3431 W 67TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4316
Practice Address - Country:US
Practice Address - Phone:714-909-8507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No175M00000XOther Service ProvidersMidwife, LayGroup - Multi-Specialty