Organization
CENTRAL REHABILITATION CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY M BLOOM MD (PRESIDENT)
(805) 543-2724
Entity
Organization
Contact information
Practice address
1334 MARSH ST, SAN LUIS OBISPO, CA 93401-3316
(805) 543-2724
(805) 543-5270
Mailing address
1334 MARSH ST, SAN LUIS OBISPO, CA 93401-3316
(805) 543-2724
(805) 543-5270
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G72622
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ75365Z
BLUE SHIELD GROUP PIN
CA
Enumeration date
07/06/2006
Last updated
10/07/2011
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