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General NPI Number Information
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NPI Number | 1881900504
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Entity Type | Individual
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Provider Name | JAMEELA RAASHIDA FULTON D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 08/19/2010
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Last Update Date | 10/01/2016
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Provider Practice Location Address
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Address Line | 43049 GRIMMER TER
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City | FREMONT
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State | CA
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Zip | 94538-5973
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Country | US
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Telephone | 602-885-8562
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 102
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City | FREMONT
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State | CA
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Zip | 94537-0102
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Country | US
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Telephone | 602-885-8562
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E 4823
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License Number State | CA
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