Healthcare Provider Details

I. General information

NPI: 1881883320
Provider Name (Legal Business Name): PHYLLIS A CULLEN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 COHASSET RD SUITE 110
CHICO CA
95926-2236
US

IV. Provider business mailing address

PO BOX 1477
HILO HI
96721-1477
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-0325
  • Fax:
Mailing address:
  • Phone: 530-895-3287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC CULLEN
Title or Position: SECRETARY
Credential:
Phone: 530-895-3287