Healthcare Provider Details

I. General information

NPI: 1003791526
Provider Name (Legal Business Name): ALICIA KATHLEEN SCULL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41637 MARGARITA RD STE 100
TEMECULA CA
92591-2990
US

IV. Provider business mailing address

41637 MARGARITA RD STE 100
TEMECULA CA
92591-2990
US

V. Phone/Fax

Practice location:
  • Phone: 951-296-9300
  • Fax: 951-296-6398
Mailing address:
  • Phone: 951-296-9300
  • Fax: 951-296-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: