Provider Demographics
NPI:1639482813
Name:IRWIN L. BLISS M.D. A PROFESSIONAL CORP.
Entity type:Organization
Organization Name:IRWIN L. BLISS M.D. A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:LIONEL
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-553-2882
Mailing Address - Street 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2018
Mailing Address - Country:US
Mailing Address - Phone:310-553-2882
Mailing Address - Fax:323-879-2088
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:SUITE 1500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2018
Practice Address - Country:US
Practice Address - Phone:310-553-2882
Practice Address - Fax:323-879-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG14675OtherMEDICARE
CAA39307Medicare UPIN
CA0998270001Medicare NSC