Lavalle Deprice Bullard

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

13800 Heacock St
Suite C236
Moreno Valley, CA 92553-3339

Phone

(951) 653-0819

NPI assigned

Jul 13, 2011

Last updated

May 16, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Omar Camara Muhammad Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pacific Clinics

  • Community/Behavioral Health Agency
  • Ontario, CA
  • NPI 1902273923
  NPD (past)

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337126400000",
    "number": "1205124039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22058 GOLDENCHAIN ST",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925536955",
            "telephone_number": "909-720-2699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 HEACOCK ST",
            "address_2": "SUITE C236",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533339",
            "telephone_number": "951-653-0819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "LAVALLE",
        "middle_name": "DEPRICE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-13",
        "last_updated": "2012-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OMAR",
            "last_name": "MUHAMMAD",
            "middle_name": "CAMARA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Carl Buford
• Hoang-Phuong Thi Bui, PHARM.D.
• Martin Anh Duc Bui, PHARM.D
• Trang Thi Diem Bui, PHARMD
• Tuyen Bui
• Sheneia T Bullard
• Ryan Buller, D.O.
• Shane' S Bundy, ACSW
• Courtney Burgdorff, MD
• Jordyn Larissa Burgess

• Case Manager/Care Coordinator in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Case Manager/Care Coordinator in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; 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.