| Awesome Blossom | |
|
3438 Freedom Dr Hollywood FL 33021-8451 | |
| (561) 543-0441 | |
| Not Available |
| Full Name | Awesome Blossom |
|---|---|
| Speciality | Behavior Analyst |
| Location | 3438 Freedom Dr, Hollywood, Florida |
| Authorized Official Name and Position | Alevtina Basantsov (DIRECTOR) |
| Authorized Official Contact | 5615430441 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awesome Blossom 3438 Freedom Dr Hollywood FL 33021-8451 Ph: (561) 543-0441 | Awesome Blossom 3438 Freedom Dr Hollywood FL 33021-8451 Ph: (561) 543-0441 |
| NPI Number | 1851108658 |
|---|---|
| Provider Enumeration Date | 12/16/2024 |
| Last Update Date | 12/16/2024 |
| Certification Date | 12/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851108658 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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