1558713982 NPI number — MS. CHYKIMBERLY QUANTEZ BULLARD ED.S, M.S.

Table of content: MS. CHYKIMBERLY QUANTEZ BULLARD ED.S, M.S. (NPI 1558713982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558713982 NPI number — MS. CHYKIMBERLY QUANTEZ BULLARD ED.S, M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULLARD
Provider First Name:
CHYKIMBERLY
Provider Middle Name:
QUANTEZ
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ED.S, M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558713982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8350 NW 52ND TER STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33166-7708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-744-0746
Provider Business Mailing Address Fax Number:
844-300-7683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 NE 125TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33161-6034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-883-5188
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)