Provider Demographics
NPI:1487691952
Name:HULL, ALEC M (MD)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:M
Last Name:HULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12900 PARK PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-977-4639
Mailing Address - Fax:562-741-4479
Practice Address - Street 1:14350 WHITTIER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2138
Practice Address - Country:US
Practice Address - Phone:562-696-1104
Practice Address - Fax:562-696-2885
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A627840OtherBLUE SHIELD ID #
061571OtherHEALTH NET ID #
110160877OtherRAILROAD
CA00A627840Medicaid
CA00A627840Medicaid
CAWA52784FMedicare PIN
110160877OtherRAILROAD