Healthcare Provider Details

I. General information

NPI: 1225087463
Provider Name (Legal Business Name): AMINAH M BLISS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 03/07/2023
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST SUITE 240-E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

1437 PRINCETON ST # 2
SANTA MONICA CA
90404-3055
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-3400
  • Fax: 310-854-3401
Mailing address:
  • Phone: 323-821-1941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA74690
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA74690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: