Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | C27398 | CA |
NPI | 1003189010 |
---|---|
Provider Name | Dr. Richard Bloom |
First Address | Pebble Beach, CA 93953-3004 |
Second Address | Pebble Beach, CA 93953-3004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2012 |
Last Update Date | 22/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C27398 | NARCOTICS LICENSE # AB2042012 (01) | CA |