Healthcare Provider Details

I. General information

NPI: 1033369947
Provider Name (Legal Business Name): BATYRJAN BULIBEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2008
Last Update Date: 07/21/2022
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SANTA FE DR STE 204
ENCINITAS CA
92024-5179
US

IV. Provider business mailing address

320 SANTA FE DR STE 204
ENCINITAS CA
92024-5179
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-7300
  • Fax: 760-633-3949
Mailing address:
  • Phone: 760-944-7300
  • Fax: 760-633-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA148198
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA148198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: