Healthcare Provider Details

I. General information

NPI: 1982919361
Provider Name (Legal Business Name): AARON M. SCULLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28545 HIGHWAY 18
SKYFOREST CA
92385-0578
US

IV. Provider business mailing address

PO BOX 3341
RUNNING SPRINGS CA
92382-3341
US

V. Phone/Fax

Practice location:
  • Phone: 909-336-1800
  • Fax:
Mailing address:
  • Phone: 909-336-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: