Provider Demographics
NPI:1649760919
Name:ROSALIND BULLARD ACUPUNCTURE INC.
Entity Type:Organization
Organization Name:ROSALIND BULLARD ACUPUNCTURE INC.
Other - Org Name:CITY ACUPUNCTURE SILVER LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:D
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSTOM
Authorized Official - Phone:323-522-3822
Mailing Address - Street 1:3017 LA PAZ DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2011
Mailing Address - Country:US
Mailing Address - Phone:347-572-5686
Mailing Address - Fax:
Practice Address - Street 1:2945 ROWENA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2003
Practice Address - Country:US
Practice Address - Phone:323-522-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16585261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care