Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | RN 486773 | CA |
Y | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | NP 10584 | CA |
NPI | 1043382666 |
---|---|
Provider Name | Tina Abolhassani Bloomer |
First Address | Trabuco Canyon, CA 92679-1121 |
Second Address | Orange, CA 92869-3990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/05/2012 |