MEDICARE: MR. DUPREE GABRIEL FULLER JR.

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1730022880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUPREE GABRIEL FULLER JR.

Provider Business Mailing Address
First Line	:	25115 AVENUE STANFORD LBBY A
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-1290
Country	:	US
Telephone Number	:	323-291-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	25115 AVENUE STANFORD LBBY A
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-1290
Country	:	US
Telephone Number	:	323-291-7100
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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