Provider Demographics
NPI:1811671753
Name:BULLIS, ROBIN RAE
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:RAE
Last Name:BULLIS
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 1:2557 MOWRY AVE STE 31
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1614
Mailing Address - Country:US
Mailing Address - Phone:510-745-0900
Mailing Address - Fax:510-745-0901
Practice Address - Street 1:2557 MOWRY AVE STE 31
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1614
Practice Address - Country:US
Practice Address - Phone:510-745-0900
Practice Address - Fax:510-745-0901
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7242237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist