Healthcare Provider Details

I. General information

NPI: 1598781031
Provider Name (Legal Business Name): DOUGLAS V HULSTEDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 EL DORADO ST STE C
MONTEREY CA
93940-3127
US

IV. Provider business mailing address

498 VAN BUREN ST
MONTEREY CA
93940-2624
US

V. Phone/Fax

Practice location:
  • Phone: 831-333-1207
  • Fax: 831-333-9894
Mailing address:
  • Phone: 831-402-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA423970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: