Provider Demographics
NPI:1679664502
Name:BLOOM, IRVING AARON (MD)
Entity Type:Individual
Prefix:
First Name:IRVING
Middle Name:AARON
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CEDAR RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5102
Mailing Address - Country:US
Mailing Address - Phone:760-630-9095
Mailing Address - Fax:760-630-9258
Practice Address - Street 1:130 CEDAR RD
Practice Address - Street 2:SUITE 310
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5102
Practice Address - Country:US
Practice Address - Phone:760-630-9095
Practice Address - Fax:760-630-9258
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32967207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD13818Medicare UPIN