Provider Demographics
NPI:1417994930
Name:KRULL, ALICE J (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:J
Last Name:KRULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1770
Mailing Address - Country:US
Mailing Address - Phone:858-842-1980
Mailing Address - Fax:858-726-6059
Practice Address - Street 1:11858 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2439
Practice Address - Country:US
Practice Address - Phone:858-842-1980
Practice Address - Fax:858-726-6059
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2015-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG600642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE94619Medicare UPIN
CAE94619Medicare UPIN