Provider Demographics
NPI:1447574587
Name:CULLEN, PAUL KENT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENT
Last Name:CULLEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 VIA LOS SANTOS
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1329
Mailing Address - Country:US
Mailing Address - Phone:805-964-4130
Mailing Address - Fax:
Practice Address - Street 1:4823 VIA LOS SANTOS
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-1329
Practice Address - Country:US
Practice Address - Phone:805-964-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE 30319172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker