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General NPI Number Information
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NPI Number | 1124094685
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Entity Type | Individual
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Provider Name | MIRIAM C. FULTON R.N., NP
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Gender | Female
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1798 N GAREY AVE
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City | POMONA
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State | CA
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Zip | 91767-2918
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Country | US
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Telephone | 909-865-9850
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Fax | 909-623-6354
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Provider Business Mailing Address
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Address Line | 2030 AVENIDA HACIENDA
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City | CHINO HILLS
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State | CA
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Zip | 91709-4700
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Country | US
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Telephone | 909-393-7913
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN247519
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License Number State | CA
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