Individual
MICHAEL GARY BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15243 VAN OWEN ST #403, VAN NUYS, CA 91405
(818) 988-8800
(818) 988-3416
Mailing address
15243 VAN OWEN ST #403, VAN NUYS, CA 91405
(818) 988-8800
(818) 988-3416
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
A23832
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A238320
—
CA
Enumeration date
09/21/2006
Last updated
07/09/2007
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