Healthcare Provider Details

I. General information

NPI: 1699743609
Provider Name (Legal Business Name): ROBERT PATRICK CIULLA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-0001
US

IV. Provider business mailing address

2402 BOULEVARD LOOP, SE
OLYMPIA WA
98501
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00001744
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: