Provider Demographics
NPI:1952581563
Name:TIMOTHY D. BULGARELLI
Entity Type:Organization
Organization Name:TIMOTHY D. BULGARELLI
Other - Org Name:PACIFIC PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BULGARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:626-793-7103
Mailing Address - Street 1:454 N CRAIG AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2460
Mailing Address - Country:US
Mailing Address - Phone:626-793-7103
Mailing Address - Fax:626-793-8332
Practice Address - Street 1:44404 16TH ST W
Practice Address - Street 2:SUITE 108
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2839
Practice Address - Country:US
Practice Address - Phone:661-974-7037
Practice Address - Fax:661-974-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO00731335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0510550004Medicare NSC