Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 15797 | CA |
NPI | 1508297375 |
---|---|
Provider Name | Dr. Vickie Joyce Culp |
First Address | San Diego, CA 92109-6824 |
Second Address | San Diego, CA 92109-6824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2013 |
Last Update Date | 04/12/2013 |