Provider Demographics
NPI:1801898689
Name:BLISS, IRWIN L (MD)
Entity type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:L
Last Name:BLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:#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:310-203-9384
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:#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:310-203-9384
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14675207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0998270001Medicare NSC
CAG14675Medicare PIN
CAA39307Medicare UPIN