Active NPI
Maricris Tamayo Bulaclac, PT
- Physical Therapist
- Los Angeles, CA
National Provider Identifier
1316914443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 28463
- Practice address
- 333 S Catalina St
Apt. 315
Los Angeles, CA 90020-2028 - Phone
- (213) 386-8996
- Fax
- (213) 386-8996
- NPI assigned
- Mar 7, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 28463 | CA | Primary |
Addresses
Primary practice location
333 S Catalina St
Apt. 315
Los Angeles, CA 90020-2028
Mailing address
333 S Catalina St
Apt. 315
Los Angeles, CA 90020-2028
Phone (213) 487-3276
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28463 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316914443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 S CATALINA ST",
"address_2": "APT. 315",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900202028",
"telephone_number": "213-487-3276",
"fax_number": "213-487-3276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 S CATALINA ST",
"address_2": "APT. 315",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900202028",
"telephone_number": "213-386-8996",
"fax_number": "213-386-8996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULACLAC",
"first_name": "MARICRIS",
"middle_name": "TAMAYO",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "28463",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.