Richard Bloom, MD
Individual provider Active NPI Nephrology Physician · Pebble Beach, CA
NPI 1003189010 · NPPES record last updated Feb 22, 2012
Key facts
- NPI
- 1003189010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nephrology Physician 207RN0300X
- License
- C27398 (CA)
- Practice address
- 4105 Costado Rd.
Pebble Beach, CA 93953-3004 - Phone
- (831) 626-3256
- Fax
- (831) 626-3268
- NPI assigned
- Feb 22, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C27398 | CA | MD | Nephrology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | C27398 | CA | Yes |
Addresses
Primary practice location
4105 Costado Rd.
Pebble Beach, CA 93953-3004
Mailing address
4105 Costado Rd.
Pebble Beach, CA 93953-3004
Phone (831) 626-3256
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C27398 | Other | CA | NARCOTICS LICENSE # AB2042012 |
Other providers in Pebble Beach, CA
- Alison Hunter Marriage and Family Therapy Inc
- John Paul Beaudoin
- Megan Elise Cassamas
- Diane Diniz
- John Bruce Harris
- Paul Gordon James
- Aminah Khalil
All providers in Pebble Beach, CA · Nephrology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.