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General NPI Number Information
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NPI Number | 1790743342
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Entity Type | Individual
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Provider Name | NATALYA V BULAEVA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 1750 STOCKTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204
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Country | US
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Telephone | 904-860-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 836 BAYTREE LN
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-4162
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Country | US
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Telephone | 904-860-1123
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 074839
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME117366
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License Number State | FL
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