Provider Demographics
NPI:1588135487
Name:RULLI, LISA MARIE (LE)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:RULLI
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12012 WILSHIRE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1203
Mailing Address - Country:US
Mailing Address - Phone:424-245-5407
Mailing Address - Fax:
Practice Address - Street 1:12012 WILSHIRE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1203
Practice Address - Country:US
Practice Address - Phone:424-245-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist