Healthcare Provider Details

I. General information

NPI: 1871085514
Provider Name (Legal Business Name): D.K. BULLARD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9057 SOQUEL DR. BLDG. A, SUITE D
APTOS CA
95003
US

IV. Provider business mailing address

9057 SOQUEL DR. BLDG. A, SUITE D
APTOS CA
95003
US

V. Phone/Fax

Practice location:
  • Phone: 831-662-0400
  • Fax: 831-662-0402
Mailing address:
  • Phone: 831-662-0400
  • Fax: 831-662-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number444700005
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number444700005
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID BULLARD
Title or Position: OWNER
Credential:
Phone: 831-662-0400