Healthcare Provider Details

I. General information

NPI: 1124067392
Provider Name (Legal Business Name): CRISTINA E. BULLARD CUTONE D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SANTA ANA BLVD #100
SANTA ANA CA
92701-4134
US

IV. Provider business mailing address

24242 LA CRESTA DR
DANA POINT CA
92629-2561
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT29109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: