Provider Demographics
NPI:1013412543
Name:BLOOM, LAURA (MD, MS, MBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:MD, MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 MARENGO STREET
Mailing Address - Street 2:LA GENERAL MEDICAL CENTER, INPATIENT TOWER ROOM C5L100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:234-409-8597
Mailing Address - Fax:
Practice Address - Street 1:2051 MARENGO STREET
Practice Address - Street 2:LA GENERAL MEDICAL CENTER, INPATIENT TOWER ROOM C5L100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:510-589-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1855932086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery