Provider Demographics
NPI:1588086813
Name:RULLAN, LASHELLE
Entity type:Individual
Prefix:
First Name:LASHELLE
Middle Name:
Last Name:RULLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PARK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3460
Mailing Address - Country:US
Mailing Address - Phone:925-628-5436
Mailing Address - Fax:
Practice Address - Street 1:425 DIVISADERO ST
Practice Address - Street 2:300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2242
Practice Address - Country:US
Practice Address - Phone:415-551-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker