Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A43145 | CA |
Y | 213ES0000X | Sports Medicine | A43145 | CA |
NPI | 1306872585 |
---|---|
Provider Name | Dr. Asta E. Bloze |
First Address | Van Nuys, CA 91405-3796 |
Second Address | Van Nuys, CA 91405-3796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 16/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A29668 | (02) | CA |
A43145 | CA LICENSE (01) | CA |