1326061102 NPI number — DR. PAM CULLEY-MCCULLOUGH ED.D.

Table of content: DR. PAM CULLEY-MCCULLOUGH ED.D. (NPI 1326061102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326061102 NPI number — DR. PAM CULLEY-MCCULLOUGH ED.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CULLEY-MCCULLOUGH
Provider First Name:
PAM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326061102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1081 BORDEN RD
Provider Second Line Business Mailing Address:
SUITE 105-C
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92026-2162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-796-4567
Provider Business Mailing Address Fax Number:
760-751-8658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1081 BORDEN RD
Provider Second Line Business Practice Location Address:
SUITE 105-C
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92026-2162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-796-4567
Provider Business Practice Location Address Fax Number:
760-751-8658
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY12599 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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