Provider Demographics
NPI:1801273305
Name:BLOOM, MATTHEW LEE (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LEE
Last Name:BLOOM
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1280 S VICTORIA AVENUE
Mailing Address - Street 2:SUITE #250
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7844
Mailing Address - Country:US
Mailing Address - Phone:805-351-0745
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:1280 S VICTORIA AVENUE
Practice Address - Street 2:SUITE # 250
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9300
Practice Address - Country:US
Practice Address - Phone:805-351-0745
Practice Address - Fax:805-288-6744
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2022-12-16
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Provider Licenses
StateLicense IDTaxonomies
CA20A16383208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A16383OtherSTATE LICENSE