Healthcare Provider Details

I. General information

NPI: 1710022546
Provider Name (Legal Business Name): TIMOTHY DANIEL BULGARELLI CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 N CRAIG AVE
PASADENA CA
91107-2460
US

IV. Provider business mailing address

454 N CRAIG AVE
PASADENA CA
91107-2460
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7103
  • Fax: 626-793-8332
Mailing address:
  • Phone: 626-793-7103
  • Fax: 626-793-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO00731
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO00731
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCPO00731
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: