MEDICARE: DR. JULIE M FULLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A73782	CA
2	2083X0100X	Occupational Medicine Physician	A73782	CA

General Provider Information

NPI Number	:	1194828822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE M FULLER MD

Provider Business Mailing Address
First Line	:	PO BOX 90753
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91109-0753
Country	:	US
Telephone Number	:	714-271-9022
Fax Number	:

Provider Business Practice Location Address
First Line	:	2362 MORSE AVE
Second Line	:	US HEALTHWORKS
City	:	IRVINE
State	:	CA
Zip	:	92614-6234
Country	:	US
Telephone Number	:	949-863-9103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	12/03/2021

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