MEDICARE: MR. ADAM JOSHUA FULLER LAC

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	171100000X	Acupuncturist	14009	CA

General Provider Information

NPI Number	:	1386934669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADAM JOSHUA FULLER LAC

Provider Business Mailing Address
First Line	:	5005 TEXAS ST STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3722
Country	:	US
Telephone Number	:	619-518-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 TEXAS ST STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3722
Country	:	US
Telephone Number	:	619-518-4222
Fax Number	:

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

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	06/29/2019

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