Provider Demographics
NPI:1013265123
Name:BULBULIA, ADAM DAITCH (BCBA)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:DAITCH
Last Name:BULBULIA
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 GARDENS AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5305
Mailing Address - Country:US
Mailing Address - Phone:707-467-1426
Mailing Address - Fax:
Practice Address - Street 1:282 GARDENS AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5305
Practice Address - Country:US
Practice Address - Phone:707-467-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8681103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst