Healthcare Provider Details

I. General information

NPI: 1821902784
Provider Name (Legal Business Name): MALIK CULLENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 S 1ST ST
AUSTIN TX
78704-7044
US

IV. Provider business mailing address

3616 S 1ST ST
AUSTIN TX
78704-7044
US

V. Phone/Fax

Practice location:
  • Phone: 254-432-9229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number769141
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: