Provider Demographics
NPI:1649961327
Name:BULGARA, JENNIFER (LVN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BULGARA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43100 PALM ROYALE DR APT 1716
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4905
Mailing Address - Country:US
Mailing Address - Phone:805-994-8202
Mailing Address - Fax:
Practice Address - Street 1:44100 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-9014
Practice Address - Country:US
Practice Address - Phone:760-772-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292714164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse