Individual
CHARIS MAE T. BULOSAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
624 W 9TH ST STE 103, SAN PEDRO, CA 90731-3158
(310) 775-3843
Mailing address
624 W 9TH ST STE 103, SAN PEDRO, CA 90731-3158
(562) 774-3391
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
02/11/2022
Last updated
04/20/2022
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