Basic Information
| Provider Information | |||||||||
| NPI: | 1881241503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KULD | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BA, MA, MA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 441 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ALTURAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961013457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302336312 | ||||||||
| FaxNumber: | 5302336339 | ||||||||
| Practice Location | |||||||||
| Address1: | 441 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ALTURAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961013457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302336312 | ||||||||
| FaxNumber: | 5302336339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2019 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | Other Service Providers | Specialist |
No ID Information.