Provider Demographics
NPI:1962096289
Name:BULOT, CHRISTINE THERESA (PHD, HCLD(ABB))
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:THERESA
Last Name:BULOT
Suffix:
Gender:F
Credentials:PHD, HCLD(ABB)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402A W PALM VALLEY BLVD # 105
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4237
Mailing Address - Country:US
Mailing Address - Phone:504-957-7003
Mailing Address - Fax:
Practice Address - Street 1:3810 MEDICAL PKWY STE 253
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4006
Practice Address - Country:US
Practice Address - Phone:504-957-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician