Basic Information
| Provider Information | |||||||||
| NPI: | 1871039909 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHANIE PULIKKOTTIL JOSEPH M.D. MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 324 | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945260324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258204335 | ||||||||
| FaxNumber: | 9258207996 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 S HALCYON RD | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934203817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054894261 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2017 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | SCHEIDEGGER | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9258204335 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | A137779 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.