Organization
CULINARY EXTRA CLINIC
Active
Organization
CULINARY EXTRA CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSHIKA FERNANDOPULLE MD (CEO)
(617) 454-4672
Entity
Organization
Contact information
Practice address
1961 LAS VEGAS BLVD S STE 101, LAS VEGAS, NV 89104-1310
(702) 852-0215
Mailing address
101 TREMONT ST FL 6, BOSTON, MA 02108-5004
(617) 454-4672
(617) 701-7740
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
08/15/2014
Last updated
09/14/2015
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