Healthcare Provider Details

I. General information

NPI: 1649195884
Provider Name (Legal Business Name): ANTHONY BULL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 NOGALES ST
ROWLAND HEIGHTS CA
91748-3855
US

IV. Provider business mailing address

725 S BIXEL ST APT 408B
LOS ANGELES CA
90017-2439
US

V. Phone/Fax

Practice location:
  • Phone: 626-935-8221
  • Fax:
Mailing address:
  • Phone: 626-935-8221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: