Provider Demographics
NPI:1417339961
Name:PULLEN, ANGELA NATHALIE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:NATHALIE
Last Name:PULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:NATHALIE
Other - Last Name:HALUSIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:35 CASA ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1890
Mailing Address - Country:US
Mailing Address - Phone:805-595-1808
Mailing Address - Fax:805-595-1815
Practice Address - Street 1:35 CASA ST STE 220
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405
Practice Address - Country:US
Practice Address - Phone:805-595-1808
Practice Address - Fax:805-595-1815
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT208906207V00000X
CAA162491207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology