Blossom Medspa & Wellness Clinic, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

PA9101508 Issued in FL

Legal business name

BLOSSOM MEDSPA & WELLNESS CLINIC, LLC

Practice address

2304 S Babcock St
Melbourne, FL 32901-5308

Phone

(321) 837-3935

NPI assigned

Jan 30, 2015

Last updated

Jan 30, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Naresh Maneklal Davda, PA

Title

Owner

Phone

(321) 837-3935

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422576000000",
    "number": "1760872600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 S BABCOCK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015308",
            "telephone_number": "321-837-3935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 S BABCOCK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329015308",
            "telephone_number": "321-837-3935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM MEDSPA & WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-30",
        "last_updated": "2015-01-30",
        "status": "A",
        "authorized_official_last_name": "DAVDA",
        "authorized_official_first_name": "NARESH",
        "authorized_official_middle_name": "MANEKLAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-837-3935",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "PA9101508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Blizzard
• Jessica B Block
• Regan Blomquist
• Bloom Family Medicine, PLLC
• Rosemarie Walsh Bloom, MASSAGE THERAPIST
• Blue Wave Counseling
• Cora Marie Blum
• Ashley Blye
• Douglas Boag, ARNP
• Vonda Bobart, MD

• Medical Specialty Clinic/Center in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.