Provider Demographics
NPI:1780694307
Name:BLUMOFE, NOAH AMRAM (DPM)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:AMRAM
Last Name:BLUMOFE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1329
Mailing Address - Country:US
Mailing Address - Phone:213-623-2225
Mailing Address - Fax:
Practice Address - Street 1:1025 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1329
Practice Address - Country:US
Practice Address - Phone:213-623-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4432213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABO231ZMedicare UPIN
CAWE4432CMedicare UPIN
CAU93337Medicare UPIN