Healthcare Provider Details

I. General information

NPI: 1285985820
Provider Name (Legal Business Name): ANNETTE HULSE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2012
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 1ST ST STE 3
LOS ALTOS CA
94022-2753
US

IV. Provider business mailing address

1747 KIRCHER CT.
LOS ALTOS CA
94024-6208
US

V. Phone/Fax

Practice location:
  • Phone: 650-960-3485
  • Fax:
Mailing address:
  • Phone: 650-960-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A12412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: