Healthcare Provider Details

I. General information

NPI: 1841152352
Provider Name (Legal Business Name): JUAN SEBASTIAN PEREZ BULLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 VICTOR AVE STE A
REDDING CA
96002-1447
US

IV. Provider business mailing address

2608 VICTOR AVE STE A
REDDING CA
96002-1447
US

V. Phone/Fax

Practice location:
  • Phone: 530-948-5351
  • Fax:
Mailing address:
  • Phone: 530-789-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number1265D71D20
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: