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General NPI Number Information
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NPI Number | 1477758381
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Entity Type | Individual
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Provider Name | LORENA NOVAK BULL RD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 15681 WINTERS LN
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City | RIVERSIDE
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State | CA
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Zip | 92504-9503
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Country | US
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Telephone | 951-858-4599
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Fax |
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Provider Business Mailing Address
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Address Line | 17130 VAN BUREN BLVD # 407
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City | RIVERSIDE
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State | CA
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Zip | 92504-5905
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Country | US
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Telephone | 951-756-3953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 810043
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License Number State | CA
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