Healthcare Provider Details

I. General information

NPI: 1588287387
Provider Name (Legal Business Name): JESSICA BLOOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 H ST
CHULA VISTA CA
91910-4328
US

IV. Provider business mailing address

480 H ST
CHULA VISTA CA
91910-4328
US

V. Phone/Fax

Practice location:
  • Phone: 619-585-4044
  • Fax: 619-585-4015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA182564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: