Individual
AL BULAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NUTRITIONIST
Contact information
Practice address
65 BRASSIE LN, COTO DE CAZA, CA 92679-4942
(918) 271-1111
Mailing address
65 BRASSIE LN, COTO DE CAZA, CA 92679-4942
(918) 271-1111
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
03/12/2025
Last updated
03/12/2025
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