Active NPI
Andrea Denise Bullock
- Recreation Therapist
- Norwalk, CA
National Provider Identifier
1871297564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 5303-T
- Practice address
- 12636 Bloomfield Ave Apt 51
Norwalk, CA 90650-1411 - Phone
- (310) 228-7577
- NPI assigned
- Mar 28, 2023
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 5303-T | CA | Primary |
Addresses
Primary practice location
12636 Bloomfield Ave Apt 51
Norwalk, CA 90650-1411
Mailing address
14445 Olive View Dr # 1D120
Sylmar, CA 91342-1437
Phone (747) 210-4204
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 |
|---|---|---|---|
| 5303-T | CA | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679961600000",
"number": "1871297564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14445 OLIVE VIEW DR # 1D120",
"city": "SYLMAR",
"state": "CA",
"postal_code": "913421437",
"telephone_number": "747-210-4204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12636 BLOOMFIELD AVE APT 51",
"city": "NORWALK",
"state": "CA",
"postal_code": "906501411",
"telephone_number": "310-228-7577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "ANDREA",
"middle_name": "DENISE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-28",
"last_updated": "2023-03-28",
"certification_date": "2023-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "CA",
"license": "5303-T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norwalk, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.