Basic Information
| Provider Information | |||||||||
| NPI: | 1801075643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DANIEL B CULLAN II MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 LANE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919144525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194213400 | ||||||||
| FaxNumber: | 6194213557 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 LANE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919144525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194213400 | ||||||||
| FaxNumber: | 6194213557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2007 | ||||||||
| LastUpdateDate: | 01/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | CULLAN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | ORTHOPAEDIC SURGEON | ||||||||
| AuthorizedOfficialTelephone: | 6194213400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | II | ||||||||
| AuthorizedOfficialCredential: | M.D. INC. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A91104 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00A911040 | 05 | CA | MEDICAID |