Individual
JESSICA BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 W ARBOR DR # MC8465, SAN DIEGO, CA 92103-1911
(858) 657-7000
Mailing address
200 W ARBOR DR # MC8465, SAN DIEGO, CA 92103-1911
(858) 657-7000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.078268
IL
2084N0400X
Neurology Physician
Primary
A182564
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125.078268
TEMPORARY MEDICAL PERMIT (IDFPR)
IL
01
—
A182564
PHYSICIAN AND SURGEON'S LICENSE CA
—
Enumeration date
05/27/2020
Last updated
11/15/2022
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