Provider Demographics
NPI:1649169426
Name:BLOOMFIELD, JASON MICHAEL (ATP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
Last Name:BLOOMFIELD
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5141 VISTA DEL MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1448
Mailing Address - Country:US
Mailing Address - Phone:760-525-0400
Mailing Address - Fax:
Practice Address - Street 1:14761 OXNARD ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-3122
Practice Address - Country:US
Practice Address - Phone:818-793-0290
Practice Address - Fax:818-510-4809
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-28
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies