MEDICARE: TIMOTHY DANIEL BULGARELLI CPO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number
1	222Z00000X	Orthotist	CPO00731
2	224P00000X	Prosthetist	CPO00731
3	225000000X	Orthotic Fitter	CPO00731

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ42904Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710022546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY DANIEL BULGARELLI CPO

Provider Business Mailing Address
First Line	:	454 N CRAIG AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2460
Country	:	US
Telephone Number	:	626-793-7103
Fax Number	:	626-793-8332

Provider Business Practice Location Address
First Line	:	454 N CRAIG AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2460
Country	:	US
Telephone Number	:	626-793-7103
Fax Number	:	626-793-8332

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	01/25/2026

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