MEDICARE: GEORGE JAMES PULIS M.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	106H00000X	Marriage & Family Therapist	IMF 73606	CA

General Provider Information

NPI Number	:	1831438209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE JAMES PULIS M.A.

Provider Business Mailing Address
First Line	:	18870 ROBINSON RD
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-4635
Country	:	US
Telephone Number	:	707-540-4758
Fax Number	:	707-938-5744

Provider Business Practice Location Address
First Line	:	3850 MONTGOMERY DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-5207
Country	:	US
Telephone Number	:	707-546-7907
Fax Number	:

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

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	01/03/2022

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