Provider Demographics
NPI:1194741603
Name:BULMAN, LINDA DOREEN (PA-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:DOREEN
Last Name:BULMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1642
Mailing Address - Country:US
Mailing Address - Phone:510-387-4460
Mailing Address - Fax:510-524-6422
Practice Address - Street 1:2361 E 29TH ST
Practice Address - Street 2:SALEM LUTHERAN CARE CENTER
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-3511
Practice Address - Country:US
Practice Address - Phone:510-534-3637
Practice Address - Fax:510-534-3676
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1047108OtherNCCPA
CA15530OtherPA LICENSE #
OPA155300Medicare ID - Type Unspecified