Healthcare Provider Details

I. General information

NPI: 1972747210
Provider Name (Legal Business Name): ONEIL CULVER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 VICTORY BLVD SUITE 105
GLENDALE CA
91201-2946
US

IV. Provider business mailing address

1614 VICTORY BLVD SUITE 105
GLENDALE CA
91201-2946
US

V. Phone/Fax

Practice location:
  • Phone: 310-944-9322
  • Fax:
Mailing address:
  • Phone: 310-944-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA066279
License Number StateCA

VIII. Authorized Official

Name: STEPHANIE M CULVER
Title or Position: PRESIDENT
Credential: M.D
Phone: 310-944-9322