Provider Demographics
NPI:1306913793
Name:BULLARD, MONICA J (CNM)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:J
Last Name:BULLARD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 VIOLA ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1122
Mailing Address - Country:US
Mailing Address - Phone:510-867-5796
Mailing Address - Fax:
Practice Address - Street 1:2935 BECHELLI LN STE A&C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1905
Practice Address - Country:US
Practice Address - Phone:530-351-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMC 1506176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ14358Medicare UPIN