Provider Demographics
NPI:1376117622
Name:BLOOME, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BLOOME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16874 SW 49TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4907
Mailing Address - Country:US
Mailing Address - Phone:800-330-5993
Mailing Address - Fax:
Practice Address - Street 1:222 S HOLLISTON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3476
Practice Address - Country:US
Practice Address - Phone:800-330-5993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator