MEDICARE: DR. ANTONETTE MARIE ZULLI PHD

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	103T00000X	Psychologist	PSY 10762	CA

General Provider Information

NPI Number	:	1891868808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONETTE MARIE ZULLI PHD

Provider Business Mailing Address
First Line	:	6117 BROCKTON AVE
Second Line	:	SUITE 207
City	:	RIVERSIDE
State	:	CA
Zip	:	92506
Country	:	US
Telephone Number	:	951-662-8184
Fax Number	:	951-276-4769

Provider Business Practice Location Address
First Line	:	6117 BROCKTON AVE
Second Line	:	SUITE 207
City	:	RIVERSIDE
State	:	CA
Zip	:	92506
Country	:	US
Telephone Number	:	951-662-8184
Fax Number	:	951-276-4769

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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