Provider Demographics
NPI:1508332628
Name:BULL, CHERRE
Entity Type:Individual
Prefix:
First Name:CHERRE
Middle Name:
Last Name:BULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 EUREKA ST APT 29
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1671
Mailing Address - Country:US
Mailing Address - Phone:619-240-5611
Mailing Address - Fax:
Practice Address - Street 1:7520 EADS AVE STE 7
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4815
Practice Address - Country:US
Practice Address - Phone:858-434-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3341225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist