Provider Demographics
NPI:1508289414
Name:GLINES-BULL, ALLANA E (BA)
Entity Type:Individual
Prefix:MS
First Name:ALLANA
Middle Name:E
Last Name:GLINES-BULL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:ALANA
Other - Last Name:BULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13801 PARAMOUNT BLVD APT 5-202
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-6138
Mailing Address - Country:US
Mailing Address - Phone:915-355-4646
Mailing Address - Fax:
Practice Address - Street 1:2050 YOUTH WAY
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3819
Practice Address - Country:US
Practice Address - Phone:714-871-9264
Practice Address - Fax:714-871-5032
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program