Provider Demographics
NPI:1356957047
Name:MATTHEW L. BLOOM, D.O., PC
Entity type:Organization
Organization Name:MATTHEW L. BLOOM, D.O., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-351-0745
Mailing Address - Street 1:1280 S VICTORIA AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6521
Mailing Address - Country:US
Mailing Address - Phone:805-351-0745
Mailing Address - Fax:
Practice Address - Street 1:1280 S VICTORIA AVE STE 250
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6521
Practice Address - Country:US
Practice Address - Phone:805-351-0745
Practice Address - Fax:805-288-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A16383OtherCALIFORNIA DO MEDICAL LICENSE