Individual
ALEXANDER JORDAN TY STULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
409 CAMINO DEL RIO S STE 201, SAN DIEGO, CA 92108-3505
(619) 381-7748
Mailing address
4930 NAPLES ST, SAN DIEGO, CA 92110-3820
(619) 276-1176
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
04/17/2023
Last updated
04/27/2023
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