Individual
DR. JODY COREY-BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
8950 VILLA LA JOLLA DR, C129, LA JOLLA, CA 92037-1714
(858) 246-1288
(858) 246-1283
Mailing address
8950 VILLA LA JOLLA DR, C129, LA JOLLA, CA 92037-1714
(858) 246-1288
(858) 246-1283
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G062847
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G628470
—
CA
01
—
00G628470C06
CALOPTIMA PROVIDER NUMBER
CA
01
—
130007027
RAILROAD MEDICARE
—
01
—
4845
CMS
—
Enumeration date
10/11/2006
Last updated
04/06/2016
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