Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | A22950 | CA |
NPI | 1225105240 |
---|---|
Provider Name | William P. Tully |
First Address | Baldwin Park, CA 91706-5806 |
Second Address | Baldwin Park, CA 91706-5806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 23/09/2008 |