Organization
LARRY A BULAHAO DPM PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY AJOLO BULAHAO DPM (OWNER)
(210) 599-3008
Entity
Organization
Contact information
Practice address
8835 SAGEBRUSH LN, SAN ANTONIO, TX 78217-5822
(210) 599-3008
(210) 599-6175
Mailing address
8835 SAGEBRUSH LN, SAN ANTONIO, TX 78217-5822
(210) 599-3008
(210) 599-6175
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
1606
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157842901
—
TX
01
—
P00216950
RR MCR
—
Enumeration date
09/27/2007
Last updated
03/20/2008
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