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General NPI Number Information
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NPI Number | 1366519985
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Entity Type | Individual
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Provider Name | KATHLEEN JUNE FULMER ARNP
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10941 BLOOMFIELD ST SUITE #A
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2530
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Country | US
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Telephone | 568-596-1667
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Fax |
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Provider Business Mailing Address
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Address Line | 6 BARNEBURG
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City | DOVE CANYON
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State | CA
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Zip | 92679-4210
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Country | US
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Telephone | 949-589-2808
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13693
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License Number State | CA
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