Individual
CARNESHA MISHELL BULLOCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 IRIS TRL, PERRIS, CA 92571-7543
(909) 328-0985
Mailing address
1215 IRIS TRL, PERRIS, CA 92571-7543
(909) 328-0985
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
94025611
CA
Other
Enumeration date
01/06/2021
Last updated
01/06/2021
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