Provider Demographics
NPI:1649350737
Name:CULLER, KIRSTEN M (MD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:M
Last Name:CULLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2415 W VINE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3731
Mailing Address - Country:US
Mailing Address - Phone:209-333-3135
Mailing Address - Fax:209-333-3132
Practice Address - Street 1:2415 W VINE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3731
Practice Address - Country:US
Practice Address - Phone:209-333-3135
Practice Address - Fax:209-333-3132
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA000000A63080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics