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DR. KRISTEN MICHELE FULLER M.D.
>> Organized Health Care Education/Training Program >> StudentRegistrant NPI Number: 1053654269
Individual Registrant:DR. KRISTEN MICHELE FULLER M.D.
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
9461 FEATHERHILL DR VILLA PARK, CA 92861-2613 US
Tel: 805-252-6828 Fax: --
Tel: 805-252-6828 Fax: --
Contact information for business:
9461 FEATHERHILL DR VILLA PARK, CA 92861-2613 US
Tel: 805-252-6828 Fax: --
Tel: 805-252-6828 Fax: --
Registration Information:
NPI: 1053654269
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 390200000X | Student Organized Health Care Education/Training Program |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
