Healthcare Provider Details

I. General information

NPI: 1184252579
Provider Name (Legal Business Name): ABYGAIL MARIE DULLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12602 AMARGOSA RD STE F
VICTORVILLE CA
92392-7640
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 760-261-5000
  • Fax:
Mailing address:
  • Phone: 314-362-7200
  • Fax: 314-747-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA208765
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2024049590
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: