Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | DR.0060290 | CO |
NPI | 1366836512 |
---|---|
Provider Name | Dr. Jessica Lynn Bloom |
First Address | Aurora, CO 80045-2570 |
Second Address | Aurora, CO 80045-7106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2015 |
Last Update Date | 15/06/2020 |