Provider Demographics
NPI:1659451979
Name:CULLEN, NIALL MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NIALL
Middle Name:MICHAEL
Last Name:CULLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:37 COSTA BRAVA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-9347
Mailing Address - Country:US
Mailing Address - Phone:949-661-5867
Mailing Address - Fax:
Practice Address - Street 1:1725 W 17TH ST
Practice Address - Street 2:BUILDING 50
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-834-8146
Practice Address - Fax:714-834-8361
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA20257207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology