Provider Demographics
NPI:1407464233
Name:BULCAO, ALEXIS MARINA (AUD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARINA
Last Name:BULCAO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:MARINA
Other - Last Name:RONNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:93 KANSAS ST APT 107
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1468
Mailing Address - Country:US
Mailing Address - Phone:619-857-2843
Mailing Address - Fax:
Practice Address - Street 1:197 E CAROLINE ST STE 1100
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3731
Practice Address - Country:US
Practice Address - Phone:909-558-2824
Practice Address - Fax:909-558-2387
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist