Provider Demographics
NPI:1750323184
Name:DULLA, ROLAND (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:DULLA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10324 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-7212
Mailing Address - Country:US
Mailing Address - Phone:562-867-2028
Mailing Address - Fax:949-861-8601
Practice Address - Street 1:17332 VON KARMAN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6242
Practice Address - Country:US
Practice Address - Phone:949-861-8600
Practice Address - Fax:949-861-8601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ64712Medicare UPIN