Provider Demographics
NPI:1932258704
Name:BULCZYNSKI, ANDRZEJ (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:ANDRZEJ
Middle Name:
Last Name:BULCZYNSKI
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13160 MINDANAO WAY
Mailing Address - Street 2:SUITE# 300
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6358
Mailing Address - Country:US
Mailing Address - Phone:310-574-0400
Mailing Address - Fax:310-574-0485
Practice Address - Street 1:13160 MINDANAO WAY
Practice Address - Street 2:SUITE# 300
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6358
Practice Address - Country:US
Practice Address - Phone:310-574-0400
Practice Address - Fax:310-574-0485
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89040207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI14846Medicare UPIN