Healthcare Provider Details

I. General information

NPI: 1679799761
Provider Name (Legal Business Name): STEPHANIE R. BLOOM M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSF MEDICAL CENTER CHILDRENS HOSPITAL 400 PARNASSUS AVENUE 2ND FLOOR
SAN FRANCISCO CA
94143-0374
US

IV. Provider business mailing address

UCSF MEDICAL CENTER CHILDRENS HOSPITAL 400 PARNASSUS AVENUE 2ND FLOOR
SAN FRANCISCO CA
94143-0374
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2000
  • Fax:
Mailing address:
  • Phone: 415-353-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG72493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: