Healthcare Provider Details

I. General information

NPI: 1194174839
Provider Name (Legal Business Name): BRIAN TULLIS ANDREW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 07/14/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

V. Phone/Fax

Practice location:
  • Phone: 703-209-6837
  • Fax:
Mailing address:
  • Phone: 703-209-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA193043
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: