Provider Demographics
NPI:1053296095
Name:BLOSE, STEPHEN HOWARD (VMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HOWARD
Last Name:BLOSE
Suffix:
Gender:M
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CORTE MADERA AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-4505
Mailing Address - Country:US
Mailing Address - Phone:415-302-5201
Mailing Address - Fax:
Practice Address - Street 1:333 CORTE MADERA AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-4505
Practice Address - Country:US
Practice Address - Phone:415-302-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker