Provider Demographics
NPI:1891868808
Name:ZULLI, ANTONETTE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTONETTE
Middle Name:MARIE
Last Name:ZULLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 BROCKTON AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506
Mailing Address - Country:US
Mailing Address - Phone:951-662-8184
Mailing Address - Fax:951-276-4769
Practice Address - Street 1:6117 BROCKTON AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-662-8184
Practice Address - Fax:951-276-4769
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10762103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL107620Medicare ID - Type Unspecified