Individual
SAMUEL BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11015 BLOOMFIELD AVE, SANTA FE SPRINGS, CA 90670-4601
(562) 906-2676
Mailing address
1003 7TH AVE, KIRKLAND, WA 98033-5779
(425) 658-3016
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
MPSS-HNATRW
CA
Other
Enumeration date
10/14/2019
Last updated
01/16/2026
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