Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO00731 | |
N | 222Z00000X | Podiatrist | CPO00731 | |
N | 224P00000X | Prosthetist | CPO00731 | |
N | 225000000X | Orthotic Fitter | CPO00731 |
NPI | 1710022546 |
---|---|
Provider Name | Timothy Daniel Bulgarelli |
First Address | Pasadena, CA 91107-2460 |
Second Address | Pasadena, CA 91107-2460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XC0007310 | (05) | CA |
ZZZ42904Z | BLUE SHIELD OF CALIFORNIA (01) | CA |