Healthcare Provider Details

I. General information

NPI: 1962096289
Provider Name (Legal Business Name): CHRISTINE THERESA BULOT PH.D., HCLD(ABB)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 01/12/2023
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 MEDICAL PKWY STE 253
AUSTIN TX
78756-4006
US

IV. Provider business mailing address

402A W PALM VALLEY BLVD # 105
ROUND ROCK TX
78664-4237
US

V. Phone/Fax

Practice location:
  • Phone: 504-957-7003
  • Fax:
Mailing address:
  • Phone: 504-957-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: