Healthcare Provider Details

I. General information

NPI: 1851652309
Provider Name (Legal Business Name): BENJAMIN DENNIS CULLEN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 CAMINO DEL RIO N STE 101
SAN DIEGO CA
92108-1630
US

IV. Provider business mailing address

770 WASHINGTON ST #202
SAN DIEGO CA
92103-2209
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-0777
  • Fax: 619-291-3231
Mailing address:
  • Phone: 619-291-0777
  • Fax: 619-291-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL1834
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: