Individual
ANDREA MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
700 RIVER DR, FORT BRAGG, CA 95437-5403
(707) 961-4655
Mailing address
2107 LIVINGSTON ST, SUITE A, OAKLAND, CA 94606-5218
(510) 436-9000
(510) 436-9013
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
A61951
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A619510
—
CA
Enumeration date
10/02/2006
Last updated
06/24/2008
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