Provider Demographics
NPI:1285970848
Name:BANGSAL, BULLET KEDDY
Entity type:Individual
Prefix:
First Name:BULLET
Middle Name:KEDDY
Last Name:BANGSAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 DE ANZA WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-6250
Mailing Address - Country:US
Mailing Address - Phone:805-201-5378
Mailing Address - Fax:
Practice Address - Street 1:341 DE ANZA WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-6250
Practice Address - Country:US
Practice Address - Phone:805-201-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health