Provider Demographics
NPI:1730639683
Name:BLOOM OBSTETRICS AND GYNECOLOGY, INC
Entity Type:Organization
Organization Name:BLOOM OBSTETRICS AND GYNECOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEETU
Authorized Official - Middle Name:KHURANA
Authorized Official - Last Name:SODHI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-723-9153
Mailing Address - Street 1:18555 VENTURA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4192
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18555 VENTURA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4192
Practice Address - Country:US
Practice Address - Phone:209-613-2927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12852207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty