Healthcare Provider Details

I. General information

NPI: 1619409232
Provider Name (Legal Business Name): MONICA TAYLOR BULLOCK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5646
  • Fax: 719-776-8050
Mailing address:
  • Phone: 719-776-5646
  • Fax: 719-776-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberDR.0061153
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: