Healthcare Provider Details

I. General information

NPI: 1982516142
Provider Name (Legal Business Name): ASHLEY FULLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 800
LA JOLLA CA
92037-1219
US

IV. Provider business mailing address

9850 GENESEE AVE STE 800
LA JOLLA CA
92037-1219
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-9177
  • Fax:
Mailing address:
  • Phone: 858-552-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License Number716494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: