Provider Demographics
NPI:1982814067
Name:MCCULLY, SAMIA (ND)
Entity Type:Individual
Prefix:DR
First Name:SAMIA
Middle Name:
Last Name:MCCULLY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6520
Mailing Address - Country:US
Mailing Address - Phone:650-233-7327
Mailing Address - Fax:650-233-7330
Practice Address - Street 1:2100 GORDON AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6520
Practice Address - Country:US
Practice Address - Phone:650-233-7327
Practice Address - Fax:650-233-7330
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND195175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath