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General NPI Number Information
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NPI Number | 1912748252
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Entity Type | Organization
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Legal Business Name | FUSION HEALTH APC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 2087 GRAND CANAL BLVD STE 12
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City | STOCKTON
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State | CA
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Zip | 95207-6651
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Country | US
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Telephone | 209-888-8602
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Fax | 209-888-8603
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Provider Business Mailing Address
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Address Line | 2087 GRAND CANAL BLVD STE 12
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City | STOCKTON
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State | CA
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Zip | 95207-6651
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Country | US
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Telephone | 209-888-8602
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Fax | 209-888-8603
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Authorized Official
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Title or Position | CFO
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Name | DR. ROBERT JOHN SHAPIRO
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Credential | DC
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Telephone | 209-888-8602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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