Provider Demographics
NPI:1972118735
Name:DULL, ALAN LEE
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:LEE
Last Name:DULL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 WILKERSON AVE STE C-D
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-2200
Mailing Address - Country:US
Mailing Address - Phone:951-345-6378
Mailing Address - Fax:
Practice Address - Street 1:170 WILKERSON AVE STE C-D
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2200
Practice Address - Country:US
Practice Address - Phone:951-345-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist