Provider Demographics
NPI:1992124606
Name:DECULING, EROL (NP)
Entity type:Individual
Prefix:
First Name:EROL
Middle Name:
Last Name:DECULING
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WALNUT WOODS CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9656
Mailing Address - Country:US
Mailing Address - Phone:209-872-4323
Mailing Address - Fax:888-879-5356
Practice Address - Street 1:501 S BROOKHURST RD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-3207
Practice Address - Country:US
Practice Address - Phone:209-872-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000556363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95000556OtherLICENSE NUMBER