Provider Demographics
NPI:1093715997
Name:RULLAN, GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:RULLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:B13 CALLE 5
Mailing Address - Street 2:PRADO ALTO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3042
Mailing Address - Country:US
Mailing Address - Phone:787-784-0063
Mailing Address - Fax:787-784-0063
Practice Address - Street 1:JR5 CALLE LIZZIE GRAHAM
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3637
Practice Address - Country:US
Practice Address - Phone:787-784-0063
Practice Address - Fax:787-784-0069
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2015-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR8720174400000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No174400000XOther Service ProvidersSpecialist