# JEFFREY BLOOM D.O. INC, DBA BACK BAY MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538405220
- **Authorized official:** DR. JEFFREY HOWARD BLOOM D.O. (OWNER)
- **Authorized official phone:** (949) 263-1242

## Contact information

- **Practice address:** 20311 SW ACACIA ST, \#100, NEWPORT BEACH, CA 92660-1733
- **Practice address phone:** (949) 263-1242
- **Practice address fax:** (949) 263-1280
- **Mailing address:** 20311 SW ACACIA ST, \#100, NEWPORT BEACH, CA 92660-1733
- **Mailing address phone:** (949) 263-1242
- **Mailing address fax:** (949) 263-1280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 20A6397 | CA | Yes |

## Other

- **Enumeration date:** 12/27/2012
- **Last updated:** 12/27/2012