| NPI | 1659912723 |
|---|---|
| Doing Business As | MIND BLOOM LA JOLLA |
| Entity Type | Organization |
| Authorized Contact | KRISTIN MARIE LULICH CEO 253-218-8755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2019-09-30 |