MEDICARE: MANDEEP KAUR KULLAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	50304	CA

General Provider Information

NPI Number	:	1386658631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDEEP KAUR KULLAR

Provider Business Mailing Address
First Line	:	800 E OCEAN BLVD
Second Line	:	306
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5407
Country	:	US
Telephone Number	:	714-600-5716
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E OCEAN BLVD
Second Line	:	306
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5407
Country	:	US
Telephone Number	:	714-600-5716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	03/19/2012

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