Provider Demographics
NPI:1801666383
Name:CULVER, ANDREW ALAN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ALAN
Last Name:CULVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 NIMITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2236
Mailing Address - Country:US
Mailing Address - Phone:760-975-7966
Mailing Address - Fax:
Practice Address - Street 1:2667 CAMINO DEL RIO S STE 110-4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3707
Practice Address - Country:US
Practice Address - Phone:760-975-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35616225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist