Provider Demographics
NPI:1982862678
Name:PRIVATE MEDICAL CONSULTING
Entity Type:Organization
Organization Name:PRIVATE MEDICAL CONSULTING
Other - Org Name:DAVID R. BLOOM M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-843-6550
Mailing Address - Street 1:17822 BEACH BLVD STE 325
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7519
Mailing Address - Country:US
Mailing Address - Phone:714-843-6550
Mailing Address - Fax:714-843-6560
Practice Address - Street 1:17822 BEACH BLVD STE 325
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7519
Practice Address - Country:US
Practice Address - Phone:714-843-6550
Practice Address - Fax:714-843-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG069614173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE94626Medicare PIN