Healthcare Provider Details

I. General information

NPI: 1831061472
Provider Name (Legal Business Name): BUELLTERRA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W HIGHWAY 246
BUELLTON CA
93427-9459
US

IV. Provider business mailing address

195 W HIGHWAY 246
BUELLTON CA
93427-9459
US

V. Phone/Fax

Practice location:
  • Phone: 805-686-8555
  • Fax: 805-686-8556
Mailing address:
  • Phone: 805-686-8555
  • Fax: 805-686-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SANJAY GUNDU
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-686-8555