MEDICARE: ALICE J. KRULL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G60064	CA

General Provider Information

NPI Number	:	1417994930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE J. KRULL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1770
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91944-1770
Country	:	US
Telephone Number	:	858-842-1980
Fax Number	:	858-726-6059

Provider Business Practice Location Address
First Line	:	11858 BERNARDO PLAZA CT
Second Line	:	SUITE 210
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2439
Country	:	US
Telephone Number	:	858-842-1980
Fax Number	:	858-726-6059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	01/16/2015

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