Healthcare Provider Details

I. General information

NPI: 1366519985
Provider Name (Legal Business Name): KATHLEEN JUNE FULMER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10941 BLOOMFIELD ST SUITE #A
LOS ALAMITOS CA
90720-2530
US

IV. Provider business mailing address

6 BARNEBURG
DOVE CANYON CA
92679-4210
US

V. Phone/Fax

Practice location:
  • Phone: 568-596-1667
  • Fax:
Mailing address:
  • Phone: 949-589-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: