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General NPI Number Information
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NPI Number | 1306252481
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Entity Type | Individual
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Provider Name | LAUREN BLOOM D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3450 11TH CT SUITE 201
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City | VERO BEACH
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State | FL
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Zip | 32960-5012
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Country | US
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Telephone | 772-794-3364
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Fax | 772-794-3366
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Provider Business Mailing Address
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Address Line | 1000 36TH ST
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City | VERO BEACH
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State | FL
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Zip | 32960-4862
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Country | US
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Telephone | 772-794-5611
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Fax | 772-794-1450
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS13158
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License Number State | FL
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