Individual
MS. CRYSTAL GAYLE BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9838 FAIRFAX SQ APT 264, FAIRFAX, VA 22031-4238
(917) 214-8795
Mailing address
9838 FAIRFAX SQ APT 264, FAIRFAX, VA 22031-4238
(917) 214-8795
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
49D2314134
VA
Other
Enumeration date
03/29/2025
Last updated
03/29/2025
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