MEDICARE: CODY BULGARELLI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	58569	CA

General Provider Information

NPI Number	:	1437776283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY BULGARELLI PA-C

Provider Business Mailing Address
First Line	:	PO BOX 308
Second Line	:
City	:	KERNVILLE
State	:	CA
Zip	:	93238-0308
Country	:	US
Telephone Number	:	760-223-2456
Fax Number	:

Provider Business Practice Location Address
First Line	:	11818 SOUTHFORK VIEW CT
Second Line	:
City	:	WELDON
State	:	CA
Zip	:	93283-9509
Country	:	US
Telephone Number	:	760-223-2456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2020
Last Update Date	:	09/30/2020

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