Provider Demographics
NPI:1194237859
Name:KRULA, VIRGINIA JO (IBCLC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:JO
Last Name:KRULA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:KRULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:12453 HEATHERTON CT APT 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5187
Mailing Address - Country:US
Mailing Address - Phone:858-335-1717
Mailing Address - Fax:
Practice Address - Street 1:12453 HEATHERTON CT APT 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-5187
Practice Address - Country:US
Practice Address - Phone:858-335-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-104480174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN