Healthcare Provider Details

I. General information

NPI: 1013412543
Provider Name (Legal Business Name): LAURA BLOOM MD, MS, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2483
US

IV. Provider business mailing address

2051 MARENGO STREET LA GENERAL MEDICAL CENTER, INPATIENT TOWER ROOM C5L100
LOS ANGELES CA
90033
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3000
  • Fax:
Mailing address:
  • Phone: 234-409-8597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA185593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: