Provider Demographics
NPI:1336484070
Name:RULL, OSCAR V
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:V
Last Name:RULL
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 1:23970 DOHENY CIR
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7114
Mailing Address - Country:US
Mailing Address - Phone:951-732-5399
Mailing Address - Fax:
Practice Address - Street 1:23970 DOHENY CIR
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7114
Practice Address - Country:US
Practice Address - Phone:951-732-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1543619172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver