Provider Demographics
NPI:1821695842
Name:BULURAN, LESLEE
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:
Last Name:BULURAN
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 1:5808 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-6429
Mailing Address - Country:US
Mailing Address - Phone:619-944-3685
Mailing Address - Fax:
Practice Address - Street 1:BAYVIEW BEHAVIORAL HEALTH HOSPITAL
Practice Address - Street 2:330 MOSS ST
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-9191
Practice Address - Country:US
Practice Address - Phone:619-944-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW66029104100000X
CA1003911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker