Provider Demographics
NPI:1508494840
Name:BULLITT, SONDRINA (LAC)
Entity Type:Individual
Prefix:
First Name:SONDRINA
Middle Name:
Last Name:BULLITT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 HALLDALE AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1874
Mailing Address - Country:US
Mailing Address - Phone:310-357-8817
Mailing Address - Fax:
Practice Address - Street 1:349 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3729
Practice Address - Country:US
Practice Address - Phone:310-357-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18857171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist