Provider Demographics
NPI:1861404329
Name:PULLEN, ELINOR (PAC)
Entity type:Individual
Prefix:MRS
First Name:ELINOR
Middle Name:
Last Name:PULLEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3605
Mailing Address - Country:US
Mailing Address - Phone:213-483-2620
Mailing Address - Fax:213-483-7918
Practice Address - Street 1:679 S WESTLAKE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3505
Practice Address - Country:US
Practice Address - Phone:214-413-4141
Practice Address - Fax:213-484-6280
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14988207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA14988Medicaid