Individual
ANDREA DENISE BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12636 BLOOMFIELD AVE APT 51, NORWALK, CA 90650-1411
(310) 228-7577
Mailing address
14445 OLIVE VIEW DR # 1D120, SYLMAR, CA 91342-1437
(747) 210-4204
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
5303-T
CA
Other
Enumeration date
03/28/2023
Last updated
03/28/2023
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