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General NPI Number Information
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NPI Number | 1134126667
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Entity Type | Organization
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Legal Business Name | RALPH J. TULLO, MD, PA
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 300 N LAKE DESTINY RD
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City | MAITLAND
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State | FL
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Zip | 32751-4103
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Country | US
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Telephone | 407-699-6266
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Fax | 407-699-6266
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Provider Business Mailing Address
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Address Line | 300 NORTH LAKE DESTINY ROAD
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City | MAITLAND
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State | FL
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Zip | 32751-4103
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Country | US
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Telephone | 407-699-6266
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Fax | 407-699-6266
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Authorized Official
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Title or Position | ADMINISTRATOR/BILLING COORDINATOR
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Name | MS. ALICIA TULLO
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Credential | B.S.N., C.M.S.R.
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Telephone | 407-699-6266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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