Healthcare Provider Details

I. General information

NPI: 1073952024
Provider Name (Legal Business Name): FERNANDO JOSE BULA RUDAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH ST S
ST PETERSBURG FL
33701-4804
US

IV. Provider business mailing address

6680 BENNETT CREEK DR APT 932
JACKSONVILLE FL
32216-6190
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4160
  • Fax:
Mailing address:
  • Phone: 904-607-0184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18310
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA124092
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number9882
License Number StateSD
# 4
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberME152081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: