Provider Demographics
NPI:1699817445
Name:BLISS, VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:BLISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 LADERA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5254
Mailing Address - Country:US
Mailing Address - Phone:831-426-7763
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD.
Practice Address - Street 2:BLDG. 400, SUITE 200
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906
Practice Address - Country:US
Practice Address - Phone:831-755-5514
Practice Address - Fax:831-783-0720
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF55746Medicare UPIN