Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 28600 | CA |
NPI | 1013112242 |
---|---|
Provider Name | Dr. Holly Renae Bloomquist |
First Address | San Diego, CA 92107-1902 |
Second Address | San Diego, CA 92123-1637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 08/07/2007 |