MEDICARE: MR. ADAM DAITCH BULBULIA B.C.B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-11-8681	CA

General Provider Information

NPI Number	:	1013265123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADAM DAITCH BULBULIA B.C.B.A.

Provider Business Mailing Address
First Line	:	282 GARDENS AVE
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-5305
Country	:	US
Telephone Number	:	707-467-1426
Fax Number	:

Provider Business Practice Location Address
First Line	:	282 GARDENS AVE
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-5305
Country	:	US
Telephone Number	:	707-467-1426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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