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General NPI Number Information
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NPI Number | 1811221823
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Entity Type | Individual
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Provider Name | KATRINA KAY BULLARD
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Gender | Female
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 37596 COLLEGE DR UNIT 101
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City | PALM DESERT
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State | CA
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Zip | 92211-2928
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Country | US
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Telephone | 760-774-0409
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Fax |
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Provider Business Mailing Address
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Address Line | 4647 ZION AVE RM 2145
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City | SAN DIEGO
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State | CA
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Zip | 92120-2507
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Country | US
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Telephone | 760-774-0409
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 68008
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License Number State | CA
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