Provider Demographics
NPI:1629964168
Name:BLOOM, LINDSEY (ACCNS-AG)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18701 TULSA ST
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2717
Mailing Address - Country:US
Mailing Address - Phone:818-395-6956
Mailing Address - Fax:
Practice Address - Street 1:1 ADVENTIST HEALTH WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3266
Practice Address - Country:US
Practice Address - Phone:818-395-6956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5178364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine