Provider Demographics
NPI:1275593154
Name:BULKIN, ANATOLY J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANATOLY
Middle Name:J
Last Name:BULKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CRAVEN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4237
Mailing Address - Country:US
Mailing Address - Phone:760-291-6650
Mailing Address - Fax:760-737-3430
Practice Address - Street 1:2130 CITRACADO PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4151
Practice Address - Country:US
Practice Address - Phone:760-739-7666
Practice Address - Fax:760-739-7633
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79826208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G798260Medicaid
CAWG79826IMedicare PIN
CAWG79826FMedicare PIN
G21297Medicare UPIN
CAWG79826BMedicare PIN
CAWG79826EMedicare PIN
P00085414Medicare PIN
CC328ZMedicare PIN
CAWG79826CMedicare PIN
CAWG79826HMedicare PIN
CA00G798260Medicaid
CAWG79826DMedicare PIN