Basic Information
| Provider Information | |||||||||
| NPI: | 1780655639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCULL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34520 BOB WILSON DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921342098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195328225 | ||||||||
| FaxNumber: | 6195327721 | ||||||||
| Practice Location | |||||||||
| Address1: | 34520 BOB WILSON DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921342098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195328225 | ||||||||
| FaxNumber: | 6195327721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A116935 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.