Healthcare Provider Details

I. General information

NPI: 1972958627
Provider Name (Legal Business Name): CHARLOTTE HULL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LONE TREE WAY
ANTIOCH CA
94509
US

IV. Provider business mailing address

2100 POWELL ST STE 400
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 925-779-7200
  • Fax:
Mailing address:
  • Phone: 510-350-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A17162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: