Individual
DR. PETER FEDULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 W ARBOR DR, SAN DIEGO, CA 92103-9000
(619) 543-7752
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
G41977
CA
207RP1001X
Pulmonary Disease Physician
Primary
G41977
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G419770
—
CA
Enumeration date
07/12/2006
Last updated
01/17/2019
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