Individual
JASON ADRIAN ALONSO BULATAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 PINE AVE STE 400, LONG BEACH, CA 90802-3039
(714) 400-1781
Mailing address
200 PINE AVE STE 400, LONG BEACH, CA 90802-3039
(714) 400-1781
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21522747
KAISER PERMANENTE
CA
Enumeration date
01/09/2023
Last updated
04/24/2023
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