Provider Demographics
NPI:1972747210
Name:ONEIL CULVER INC
Entity Type:Organization
Organization Name:ONEIL CULVER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CULVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-944-9322
Mailing Address - Street 1:1614 VICTORY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2946
Mailing Address - Country:US
Mailing Address - Phone:310-944-9322
Mailing Address - Fax:
Practice Address - Street 1:1614 VICTORY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2946
Practice Address - Country:US
Practice Address - Phone:310-944-9322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066279207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G90004Medicare UPIN