Provider Demographics
NPI:1992865281
Name:CULLEN, AMY RUTH (MD, MA)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:RUTH
Last Name:CULLEN
Suffix:
Gender:F
Credentials:MD, MA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:484 CALLE CADIZ B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-8925
Mailing Address - Country:US
Mailing Address - Phone:949-887-1017
Mailing Address - Fax:949-234-6603
Practice Address - Street 1:484 CALLE CADIZ UNIT B
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-8925
Practice Address - Country:US
Practice Address - Phone:949-887-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine