Provider Demographics
NPI:1629835210
Name:BULLER, CINDI LOU
Entity Type:Individual
Prefix:
First Name:CINDI
Middle Name:LOU
Last Name:BULLER
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 1:6021 N LA CANADA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1028
Mailing Address - Country:US
Mailing Address - Phone:520-979-6185
Mailing Address - Fax:877-552-1061
Practice Address - Street 1:6021 N LA CANADA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1028
Practice Address - Country:US
Practice Address - Phone:520-979-6185
Practice Address - Fax:877-552-1061
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL12583H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility