Healthcare Provider Details

I. General information

NPI: 1861982076
Provider Name (Legal Business Name): DAVID LYNN DULL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 PICO BLVD
SANTA MONICA CA
90405-1416
US

IV. Provider business mailing address

1845 BUTLER AVE APT 304
LOS ANGELES CA
90025-5496
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6200
  • Fax:
Mailing address:
  • Phone: 310-433-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: