| NPI | 1538405220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY HOWARD BLOOM Owner 949-263-1242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A6397) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2012-12-27 |