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General NPI Number Information
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NPI Number | 1578567822
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Entity Type | Individual
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Provider Name | GITTE S. BLOOM M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 607 S GLENOAKS BLVD
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City | BURBANK
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State | CA
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Zip | 91502-1424
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Country | US
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Telephone | 818-557-2671
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Fax | 818-557-0761
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Provider Business Mailing Address
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Address Line | 777 FLOWER ST STE A
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City | GLENDALE
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State | CA
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Zip | 91201-3000
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Country | US
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Telephone | 818-557-2671
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Fax | 818-557-0761
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A72269
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License Number State | CA
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