Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G42243 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G42243 | CA |
Y | 207NS0135X | Procedural Dermatology | G42243 | CA |
NPI | 1114963170 |
---|---|
Provider Name | Dr. Peter P Rullan |
First Address | Chula Vista, CA 91910-2650 |
Second Address | Chula Vista, CA 91910-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 07/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A89753 | (02) | CA |
ZZZ73699Z | (05) | CA |