Provider Demographics
NPI:1487655536
Name:DULLY, KATHLEEN MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:DULLY
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC 5014
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-5980
Mailing Address - Fax:858-312-5360
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:MC 5014
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5980
Practice Address - Fax:858-312-5360
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG72961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G729610OtherMEDI-CAL