Individual
MIRIAM K BULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1411 E 31ST ST, OAKLAND, CA 94602-1018
(510) 437-4965
Mailing address
5528 PACHECO BLVD, STE A, PACHECO, CA 94553-5126
(925) 363-8170
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A79511
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A795110
—
CA
Enumeration date
01/18/2007
Last updated
07/08/2007
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