Provider Demographics
NPI:1437915378
Name:BULATAO, LAURA ELLEN (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:BULATAO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1959 KINGSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3417
Mailing Address - Country:US
Mailing Address - Phone:310-214-1000
Mailing Address - Fax:
Practice Address - Street 1:1959 KINGSDALE AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3417
Practice Address - Country:US
Practice Address - Phone:310-214-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner