Provider Demographics
NPI:1629364716
Name:BLOOM, RENA (ND)
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 S PARKER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-7550
Mailing Address - Country:US
Mailing Address - Phone:303-337-4884
Mailing Address - Fax:
Practice Address - Street 1:1181 S PARKER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-7550
Practice Address - Country:US
Practice Address - Phone:303-337-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR760175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath