MEDICARE: BLOOD ON THE GO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1013393420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOD ON THE GO

Provider Business Mailing Address
First Line	:	4858 W PICO BLVD # 184
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-4225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 1/2 W WASHINGTON BLVD
Second Line	:	SUITE 206
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1424
Country	:	US
Telephone Number	:	323-474-9033
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KIMBERLY JONES
Credential	:
Telephone Number	:	323-740-6999

Provider Enumeration Date	:	08/07/2015
Last Update Date	:	05/06/2020

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Directions to “BLOOD ON THE GO ” Practice Location

Language	Start Address	Practice Location

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