Healthcare Provider Details

I. General information

NPI: 1508494840
Provider Name (Legal Business Name): SONDRINA BULLITT L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 RICHMOND ST
EL SEGUNDO CA
90245-3729
US

IV. Provider business mailing address

4121 HALLDALE AVE APT 202
LOS ANGELES CA
90062-1874
US

V. Phone/Fax

Practice location:
  • Phone: 310-357-8817
  • Fax:
Mailing address:
  • Phone: 310-357-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: