Organization
JEFFREY BLOOM D.O. INC, DBA BACK BAY MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY HOWARD BLOOM D.O. (OWNER)
(949) 263-1242
Entity
Organization
Contact information
Practice address
20311 SW ACACIA ST, #100, NEWPORT BEACH, CA 92660-1733
(949) 263-1242
(949) 263-1280
Mailing address
20311 SW ACACIA ST, #100, NEWPORT BEACH, CA 92660-1733
(949) 263-1242
(949) 263-1280
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
20A6397
CA
Other
Enumeration date
12/27/2012
Last updated
12/27/2012
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