Provider Demographics
NPI:1629636519
Name:BULNES, JODIE
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:BULNES
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 1:2310 W. BUSINESS HWY 77
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586
Mailing Address - Country:US
Mailing Address - Phone:956-361-4629
Mailing Address - Fax:
Practice Address - Street 1:2310 W. BUSINESS HWY 77
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586
Practice Address - Country:US
Practice Address - Phone:956-361-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58801104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker