Provider Demographics
NPI:1386658631
Name:KULLAR, MANDEEP KAUR
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:KAUR
Last Name:KULLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E OCEAN BLVD
Mailing Address - Street 2:306
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5407
Mailing Address - Country:US
Mailing Address - Phone:714-600-5716
Mailing Address - Fax:
Practice Address - Street 1:800 E OCEAN BLVD
Practice Address - Street 2:306
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5407
Practice Address - Country:US
Practice Address - Phone:714-600-5716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50304106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist