Individual
NATALYA V BULAEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1750 STOCKTON ST, JACKSONVILLE, FL 32204
(904) 860-1123
Mailing address
836 BAYTREE LN, PONTE VEDRA BEACH, FL 32082-4162
(904) 860-1123
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
074839
GA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME117366
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003169167A
—
GA
Enumeration date
05/03/2006
Last updated
07/31/2018
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