Provider Demographics
NPI:1043008303
Name:BULLAS, AMY (PPS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BULLAS
Suffix:
Gender:
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-9649
Mailing Address - Country:US
Mailing Address - Phone:831-620-8195
Mailing Address - Fax:
Practice Address - Street 1:35 FORD RD
Practice Address - Street 2:
Practice Address - City:CARMEL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93924-9649
Practice Address - Country:US
Practice Address - Phone:831-620-8195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271901041C0700X
CA1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical