Healthcare Provider Details

I. General information

NPI: 1053542837
Provider Name (Legal Business Name): DANIELLE LOTUS DULLINGER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEDICAL CENTER DR
MURRIETA CA
92562-5965
US

IV. Provider business mailing address

3156 VISTA WAY SUITE 405
OCEANSIDE CA
92056-3622
US

V. Phone/Fax

Practice location:
  • Phone: 951-696-6000
  • Fax:
Mailing address:
  • Phone: 760-439-6581
  • Fax: 760-439-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: