MEDICARE: BRUCE A. BULLIAS, M.D., INC.

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	207R00000X	Internal Medicine Physician	G27217	CA

General Provider Information

NPI Number	:	1306871884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE A. BULLIAS, M.D., INC.

Provider Business Mailing Address
First Line	:	6007 WHITTIER BLVD
Second Line	:
City	:	EAST LOS ANGELES
State	:	CA
Zip	:	90022-4401
Country	:	US
Telephone Number	:	323-728-3872
Fax Number	:	323-728-9014

Provider Business Practice Location Address
First Line	:	6007 WHITTIER BLVD
Second Line	:
City	:	EAST LOS ANGELES
State	:	CA
Zip	:	90022-4401
Country	:	US
Telephone Number	:	323-728-3872
Fax Number	:	323-728-9014

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRUCE A. BULLIAS
Credential	:	M.D.
Telephone Number	:	310-545-6962

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/21/2022

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