Jessica Bulala Luiz, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

26902 Issued in CA

Practice address

440 Grand Ave Ste 450
Oakland, CA 94610-5062

Phone

(410) 456-5773

NPI assigned

Aug 19, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jessica Marie Bulala Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1104106392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 GRAND AVE STE 450",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946105062",
            "telephone_number": "410-456-5773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 GRAND AVE STE 450",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946105062",
            "telephone_number": "410-456-5773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5665 College Ave",
            "address_2": "Suite 240D",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "94618",
            "country_code": "US",
            "telephone_number": "410-456-5773",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Bon Air Rd",
            "address_purpose": "LOCATION",
            "city": "Greenbrae",
            "state": "CA",
            "postal_code": "949041702",
            "country_code": "US",
            "telephone_number": "415-473-6830",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5661 Keith Ave Ste 203",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "94618",
            "country_code": "US",
            "telephone_number": "410-456-5773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUIZ",
        "first_name": "JESSICA",
        "middle_name": "BULALA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-19",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY26902",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "26902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178548",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BULALA",
            "middle_name": "MARIE",
            "credential": "M.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Yee-Bun B Lui, M.D.
• Steven Luibrand
• Alberto Luis Delgado
• Sean Luis
• Zack Luis
• Ronald Luk
• Amber Lea Luke
• Cyndi Lukk, LMFT
• Rosemary Elizabeth Lum-Levine, SOCIAL WORKER
• Brian K Lum, PHARM.D.

• Clinical Psychologist in Oakland, CA
• Providers in Oakland, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.