Provider Demographics
NPI:1285092387
Name:ALICE J KRULL MD INC
Entity type:Organization
Organization Name:ALICE J KRULL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-842-1980
Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1770
Mailing Address - Country:US
Mailing Address - Phone:858-842-1980
Mailing Address - Fax:858-726-6059
Practice Address - Street 1:11858 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2439
Practice Address - Country:US
Practice Address - Phone:858-842-1980
Practice Address - Fax:858-726-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty