Healthcare Provider Details

I. General information

NPI: 1467394874
Provider Name (Legal Business Name): BLOOM MEDICAL GROUP CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 W SHAW AVE
CLOVIS CA
93612-3601
US

IV. Provider business mailing address

8 CAMPUS DR STE 105
PARSIPPANY NJ
07054-4409
US

V. Phone/Fax

Practice location:
  • Phone: 551-293-6969
  • Fax:
Mailing address:
  • Phone: 551-293-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SR0400X
TaxonomyRehabilitation Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL SALAS
Title or Position: MANAGER
Credential:
Phone: 551-293-6969