Provider Demographics
NPI:1174639355
Name:BULICK, NICOLE DENISE (ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE
Last Name:BULICK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2884 SAWTELLE BLVD
Mailing Address - Street 2:#103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3753
Mailing Address - Country:US
Mailing Address - Phone:310-966-1079
Mailing Address - Fax:
Practice Address - Street 1:24255 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90263-3999
Practice Address - Country:US
Practice Address - Phone:310-506-4169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer