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General NPI Number Information
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NPI Number | 1811034135
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Entity Type | Organization
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Legal Business Name | MARK R. PULERA, MD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 4644 LINCOLN BLVD SUITE 404
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6313
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Country | US
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Telephone | 310-823-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 4644 LINCOLN BLVD SUITE 404
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6313
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Country | US
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Telephone | 310-823-7800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK RONALD PULERA
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Credential | MD
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Telephone | 310-823-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | G081695
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License Number State | CA
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