Provider Demographics
NPI:1699287847
Name:BULLARD, ROSALIND D (LACMSTOM)
Entity type:Individual
Prefix:
First Name:ROSALIND
Middle Name:D
Last Name:BULLARD
Suffix:
Gender:F
Credentials:LACMSTOM
Other - Prefix:MS
Other - First Name:ROSALIND
Other - Middle Name:D
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC,MSTOM
Mailing Address - Street 1:2945 ROWENA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2003
Mailing Address - Country:US
Mailing Address - Phone:347-572-5686
Mailing Address - Fax:
Practice Address - Street 1:2945 ROWENA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2003
Practice Address - Country:US
Practice Address - Phone:347-572-5686
Practice Address - Fax:347-572-5686
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16585171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist