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General NPI Number Information
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NPI Number | 1235563248
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Entity Type | Individual
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Provider Name | MR. RICHARD ERICK KULLBERG
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Gender | Male
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 4126 1/2 36TH ST
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City | SAN DIEGO
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State | CA
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Zip | 92104-2307
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Country | US
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Telephone | 619-417-9634
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Fax |
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Provider Business Mailing Address
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Address Line | 3022 CAMULOS ST #A
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City | SAN DIEGO
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State | CA
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Zip | 92110-5527
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Country | US
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Telephone | 619-417-9634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN153038
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License Number State | CA
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