1205106689 NPI number — BLOOM & SPEAK BILINGUAL TX LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205106689 NPI number — BLOOM & SPEAK BILINGUAL TX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOM & SPEAK BILINGUAL TX LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205106689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15774
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85060-5774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-648-3502
Provider Business Mailing Address Fax Number:
480-499-5879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4848 E ROOSEVELT ST
Provider Second Line Business Practice Location Address:
APT. 2037
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85008-7327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-648-3502
Provider Business Practice Location Address Fax Number:
480-499-5879
Provider Enumeration Date:
01/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VIRISIMO
Authorized Official First Name:
LIZETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
480-241-6442

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  SLPA7427 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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