Individual
JOSEPH BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2990
Mailing address
1218 N CALVERT ST APT 2F, BALTIMORE, MD 21202-3976
(703) 321-6732
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95271989
CA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
95271989
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R213676
LICENSE
MD
Enumeration date
11/07/2017
Last updated
04/14/2023
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