MEDICARE: DR. GITTE S. BLOOM M.D.

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	208000000X	Pediatrics Physician	A72269	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578567822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GITTE S. BLOOM M.D.

Provider Business Mailing Address
First Line	:	777 FLOWER ST
Second Line	:	STE A
City	:	GLENDALE
State	:	CA
Zip	:	91201-3000
Country	:	US
Telephone Number	:	818-557-2671
Fax Number	:	818-557-0761

Provider Business Practice Location Address
First Line	:	607 S GLENOAKS BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-1424
Country	:	US
Telephone Number	:	818-557-2671
Fax Number	:	818-557-0761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/13/2007

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