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Individual
ANDREW JASON BLOOM
Active
Individual
ANDREW JASON BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA23203
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1112428
NCCPA IDENTIFICATION NUMBER
—
01
—
PA23203
CALIFORNIA PA-C LICENSE
CA
Enumeration date
09/12/2013
Last updated
01/03/2022
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