Provider Demographics
NPI:1295743045
Name:BULLOCK, ANDREW COLIN (DO)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:COLIN
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 33707
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3707
Mailing Address - Country:US
Mailing Address - Phone:858-492-5410
Mailing Address - Fax:858-492-5411
Practice Address - Street 1:5575 RUFFIN RD
Practice Address - Street 2:#100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1380
Practice Address - Country:US
Practice Address - Phone:858-492-5410
Practice Address - Fax:858-492-5411
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6842208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation