Provider Demographics
NPI:1912170705
Name:BLOOM MEDICAL EQUIPMENT & SUPPLY
Entity type:Organization
Organization Name:BLOOM MEDICAL EQUIPMENT & SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUWADAMILARE
Authorized Official - Middle Name:
Authorized Official - Last Name:OHONME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-978-1255
Mailing Address - Street 1:14909 CRENSHAW BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3663
Mailing Address - Country:US
Mailing Address - Phone:310-978-1255
Mailing Address - Fax:
Practice Address - Street 1:14909 CRENSHAW BLVD STE 109
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3663
Practice Address - Country:US
Practice Address - Phone:310-978-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49704332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6177390001Medicare NSC