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General NPI Number Information
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NPI Number | 1366569139
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Entity Type | Organization
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Legal Business Name | EMILY F. BLOOM, M.D., INC
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 436 N BEDFORD DR SUITE 202
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4310
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Country | US
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Telephone | 310-278-8811
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Fax | 310-278-1316
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Provider Business Mailing Address
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Address Line | 436 N BEDFORD DR SUITE 202
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4310
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Country | US
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Telephone | 310-278-8811
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Fax | 310-278-1316
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EMILY FAYE BLOOM
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Credential | M.D.
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Telephone | 310-278-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G38218
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License Number State | CA
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