Healthcare Provider Details

I. General information

NPI: 1639482813
Provider Name (Legal Business Name): IRWIN L. BLISS M.D. A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK EAST SUITE 1500
LOS ANGELES CA
90067-2018
US

IV. Provider business mailing address

2080 CENTURY PARK EAST SUITE 1500
LOS ANGELES CA
90067-2018
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-2882
  • Fax: 323-879-2088
Mailing address:
  • Phone: 310-553-2882
  • Fax: 323-879-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IRWIN LIONEL BLISS
Title or Position: OWNER
Credential: M.D.
Phone: 310-553-2882