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NPI Code Detail

MEDICARE: STELLA M. BULENGO M.D.

MEDICARE:   STELLA M. BULENGO  M.D.
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
1207N00000XDermatology PhysicianG183935CA
2207N00000XDermatology PhysicianS2739TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME129589OTHERFLFL MEDICAL LICENSE
2S2739OTHERTXTX MEDICAL LICENSE

General Provider Information

NPI Number : 1194717447
Entity Type Code : Individual
Provider Name (Legal Business Name) : STELLA M. BULENGO M.D.
Provider Business Mailing Address
First Line : 18018 OVERLOOK LOOP STE 105
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78259-1883
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3320 OAKWELL CT
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78218-3128
Country : US
Telephone Number : 210-829-5180
Fax Number : 210-829-5030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 11/13/2024

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Directions to “ STELLA M. BULENGO M.D.” Practice Location

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