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NPI Code Detail

MEDICARE: FELICIA G BLOEM PH.D.

MEDICARE: FELICIA G BLOEM PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist22800CA

General Provider Information

NPI Number : 1578872453
Entity Type Code : Individual
Provider Name (Legal Business Name) : FELICIA G BLOEM PH.D.
Provider Business Mailing Address
First Line : PO BOX 2325
Second Line :
City : VACAVILLE
State : CA
Zip : 95696-2325
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2100 PEABODY RD
Second Line :
City : VACAVILLE
State : CA
Zip : 95687-6639
Country : US
Telephone Number : 707-451-0182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2010
Last Update Date : 09/27/2010

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